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When Fire is active, it manifests as heat; when Fire is depressed and stagnant, it manifests as cold. This is because the toxin desires to vent but cannot disperse; when erupting, Qi and Blood attack the Fire-Toxin together. If symptoms appear after eruption, it indicates that the toxin is abundant and the pathogenic factor prevails. It is appropriate to use Chai Hu (Bupleuri Radix), Zhi Mu (Anemarrhenae Rhizoma), Shi Gao (Gypsum Fibrosum), and Di Gu Pi (Cortices Lycii). If constipation is present, Da Huang (Rhei Radix et Rhizoma) can be added.

There are cases where the heat is intense like being branded by a hot iron, cases where the head is warm but the feet are cold, cases where the lips are scorched and cheeks are red, cases where the complexion is cyanotic, miserable, dark, and sluggish, cases where the whole body has fever with varying degrees, and cases where Yin and Yang are completely severed. The reason for this is that the Fire-Toxin has distinctions between being hidden and manifest; there is no true absolute boundary between Cold and Heat syndromes. One should know that heat conditions vary from slight heat, half-heat, to extreme heat.

Jue syndrome refers to coldness of the hands and feet extending upwards, accompanied by loss of consciousness. This occurs when Yang Qi rises alone, and Fire surges upward with Phlegm, causing Qi obstruction and stagnation, leading to Jue. When the Qi of Heat-Toxin is depressed and blocked internally, Yuan Qi cannot circulate freely, resulting in a lack of Yang on the exterior and thus cold extremities. Treatment should involve dispersing agents supplemented with Ma Huang (Ephedrae Herba), Gui Zhi (Ramulus Cinnamomi), and Cong Bai (Sclerium Allii Cepae). If Yin deficiency leads to hyperactive Fire, internal heat generates Wind, and Fire burns and scalds, causing body heat with cold limbs; Phlegm surges with Fire, leading to unconsciousness. There is also Blood Jue, caused by excessive sweating leading to blood depletion, which causes Yang Qi to rise alone and Qi obstruction.

The head is the convergence point of all Yang meridians; toxins vaporize upward, making it warm. The six meridians of the feet belong to Water, Earth, and Wood elements: Water becomes ice when cold, Earth cracks when cold, and Wood withers when cold. Cold feet indicate the exhaustion of Yang Qi. The Classic states: "Cold feet extending above the knees are untreatable." However, if foot coldness is due to rash toxins depressing in the upper part, clearing the upper part is appropriate, so that Fire descends and feet become warm. The four limbs are governed by the Spleen and Stomach; therefore, abnormalities appearing first in the limbs are untreatable, and cold limbs persisting after the rash subsides are also untreatable.

If head sweat pours like rain after the rash, and toxins severely invade the Yang position (head), it is untreatable. If treatment is attempted, one should refer to the prescriptions recorded for the forty-ninth day mentioned earlier. This is because Fire nature flares upward, combined with no outlet for fluid excretion, preventing massive discharge; flame light窜 upward, causing sweat to surge upward as if steaming. The four limbs belong to the Spleen and should be harmonious and warm; they should not be too hot, nor particularly too cold. Whole-body heat with isolated coldness of hands and feet indicates fierce toxins suppressing Spleen Yang, preventing pathogen penetration; this is the manifestation of Cold due to Fire depression. Extreme cold is actually extreme heat. Before eruption, Ma Huang and Gui Zhi should be used to disperse, and Fire will naturally subside.