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Jue Ni (Reversal Cold) refers to the condition where the four limbs are cool, or even cold. The four limbs are the root of all Yang meridians; therefore, they should normally be warm and comfortable. If Jue Ni occurs, it indicates deficiency of Yang Qi. Slight coldness in the fingertips also signifies decline of Yang Qi. Coldness in the soles of the feet indicates an excess of Yin pathogenic factors. In cases where a sore has a blackened and scorched head, accompanied by irritability, thirst, mental confusion, constipation with hot accumulation, and Jue Ni, this is due to Yang toxin sinking inward. Extreme heat mimics water, which is referred to as "the deeper the heat, the deeper the Jue." Conversely, if the sore is grayish-white, stools are not dry, yet Jue Ni occurs, this is due to extreme exhaustion of Yuan Qi (Original Qi), resulting in cold from Yang decline. Generally, in the manifestations of smallpox/variolae, the head should prefer coolness while the feet should prefer warmth. If the head is warm but the feet are cold, it is often incurable; thus, Jue Ni is considered a ominous sign for patients with sores.

1. For variolae patients with slightly cold fingertips, Wujunzi Jian (Five Gentlemen Decoction) or Liuqi Jian (Six Qi Decoction) should be used immediately, or Liuwu Jian (Six Ingredients Decoction) added with Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger) and Rougui (Cinnamomi Cortex, Cinnamon Bark) to warm the body, preventing transformation into deficiency-cold pathology.

2. For variolae accompanied by diarrhea and Jue Ni due to Qi deficiency, Weiguan Jian (Stomach Gate Decoction) or Chen's Twelve-Ingredient Yigong San (Twelve-Ingredient Extraordinary Efficacy Powder) should be used.

3. When variolae first erupt, if the hands and feet become cold immediately, or if the patient previously suffered from vomiting and diarrhea damaging the Spleen and Stomach, leading to Spleen-Stomach Qi deficiency and subsequent Jue Ni, Liuwu Jian (Six Ingredients Decoction) or Liuqi Jian (Six Qi Decoction) added with Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger) and Rougui (Cinnamomi Cortex, Cinnamon Bark) should be the primary treatment. For severe cases, Renshen Fuzi Liyin Jian (Ginseng and Aconite Nourishing Yin Decoction) is indicated.

4. During the swelling stage of variolae, if Jue Ni of the hands and feet occurs, this is a sign that Yang Qi is about to perish. It must be accompanied by spontaneous diarrhea or vomiting, with a pulse that is deep, fine, weak, or floating, large, and empty. One must rapidly warm and tonify Yuan Yang (Original Yang). For mild cases, Liuqi Jian (Six Qi Decoction) added with Rougui (Cinnamomi Cortex, Cinnamon Bark); for severe cases, Liuwei Huiyang Yin (Six-Ingredient Returning Yang Decoction) or Jiawei Yigong Jian (Nine-Ingredient Extraordinary Efficacy Decoction). If the hands and feet become warm after taking the medicine, the prognosis is good; if Jue Ni persists, death ensues.

5. For Jue Ni caused by severe internal heat toxicity, there must be symptoms such as irritability, fever, constipation, abdominal fullness, and a slippery pulse. Sishun Qingliang Yin (Four-Obedience Clearing and Cooling Decoction) or Chengqi Tang (Chengqi Decoction) should be used.

6. For Jue Ni occurring after variolae, this is because Qi and Blood are already deficient and the Spleen and Stomach are exhausted; thus, Jue Ni is unsurprising. Baoyuan Tang (Protecting Origin Decoction), or Liuqi Jian (Six Qi Decoction)/Liuwu Jian (Six Ingredients Decoction) added with Fuzi (Aconiti Lateralis Radix Preparata, Prepared Lateral Root of Chinese Aconite) and Rougui (Cinnamomi Cortex, Cinnamon Bark) should be used.

Thirst in variolae is due to interior heat. Fire arising internally consumes Zhen Yin (True Yin), causing thirst. Additionally, when fluids leak outward to transform into pus and plasma, Ying Qi (Nutritive Qi) becomes depleted, also leading to thirst. This is a common manifestation of variolae. If the thirst is slight and not severe, no treatment is necessary. Only in cases of severe thirst, caused by excessive fire, must one differentiate between deficiency and excess to regulate treatment. One must absolutely avoid giving cold foods like watermelon, pear, or persimmon simply because the patient is thirsty, lest the Spleen and Lung suffer cold injury and generate other ailments. Dry thirst is discussed under the section on diarrhea and should be consulted.

When variolae deplete internal Qi and Blood, resulting in slight fever, slight thirst, and a preference for hot drinks, Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) or Wufu Yin (Five Blessings Decoction) added with Maidong (Ophiopogonis Radix, Ophiopogon Root) and Wuweizi (Schisandrae Chinensis Fructus, Schisandra Fruit) should be used.

1. For Spleen-Lung heat causing thirst with a preference for cold drinks, Ren Shen Maidong San (Ginseng and Ophiopogon Powder) or Sha Mai San (Pulse-Nourishing Powder) should be used.

2. For variolae with significant heat and restlessness, dry mouth and throat, severe thirst with desire to drink, preference for cold food/drink, ability to eat, or dry constipation, this indicates heat in the Lung and Stomach meridians. Ren Shen Baihu Tang (Ginseng White Tiger Decoction) should be used; for severe cases, add Huanglian (Coptidis Rhizoma, Coptis Rhizome). If fever and thirst occur after variolae, this is residual fire not yet cleared, and the treatment is the same.

3. For continuous spontaneous diarrhea in variolae causing thirst due to Kidney Yin deficiency, the disease manifests as Shao Yin syndrome. Chen's Twelve-Ingredient Yigong San (Twelve-Ingredient Extraordinary Efficacy Powder) or Jiawei Yigong Jian (Nine-Ingredient Extraordinary Efficacy Decoction) should be used urgently.

4. For dry stool constipation, abdominal fullness, irritability, and heat, causing thirst due to unclear internal fire, Sishun Qingliang Yin (Four-Obedience Clearing and Cooling Decoction) should be used.

5. When severe thirst appears immediately during the fever phase of variolae, with cracked lips and dry tongue, this indicates excessive Heart Fire and failure of Kidney Water to ascend, leading to depletion of blood and fluids. Immediate detoxification is required using Yige Gen Jiedu Tang (Coix Seed, Kudzu Root, and Rehmannia Detoxifying Decoction).

Master Cheng stated: The origin of variolae lies in Ren-Gui Water (Kidney Water). Once this water flows out, its source must be exhausted; why does it not cause thirst? From this, we can see that treating thirst requires nourishing Kidney Water without fail.

Master Xue stated: For patients desiring to drink water due to thirst, one must examine whether the heat is deficiency-type or excess-type. If it is deficiency-heat, although the patient desires water, they will not drink much; Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) should be used. If it is excess-heat, and the patient seeks water and likes to drink, Xi Jiao (Rhinocerotis Cornu, Rhino Horn - *Note: Modern substitutes like Shui Niu Jiao are used*) ground in water should be administered, after which there will be no risk of residual toxins.