Library

In miscellaneous diseases, coldness of the four limbs is caused by deficiency of Spleen and Kidney Yang Qi, which fails to reach the extremities. Si Ni Tang (Four Reversal Decoction) is the primary formula. In patients who have suffered blood loss, occasional reversal coldness may also occur; this is mostly due to pathogenic heat sinking inward and hiding within, presenting with false cold on the exterior. The body feels as cold as water, vision is blurred, spirit is dull, and the pulse is hidden and difficult to palpate. Alternatively, there may be episodes of coldness followed by fever, or reversal coldness lasting several days followed by fever for several days. When reversal coldness predominates over fever, it indicates extreme Yang transforming into Yin-like symptoms, signifying extreme heat. When reversal coldness is slight but heat is profound, it indicates that latent heat can still vent, meaning the heat is relatively superficial. This corresponds to the statement in the *Shanghan Lun* (Treatise on Cold Damage), Jueyin Chapter: "The deeper the heat, the deeper the reversal coldness; the milder the heat, the milder the reversal coldness." This is because the Jueyin Liver Meridian harbors Gallbladder Fire internally. When diseased, the fire hides within the Yin, causing reversal coldness; when the fire emerges into the Yang aspect, fever occurs. Fever indeed indicates strong fire, but reversal coldness indicates fire hiding internally and becoming even more intense. Treatment should first address the latent fire, allowing it to vent, transforming reversal coldness into fever, and then clear the remaining heat for recovery. Misidentifying this as reversal coldness from miscellaneous diseases and using warming herbs would hasten death. Differentiation: Reversal coldness from miscellaneous diseases presents with continuous vomiting and diarrhea, absent or faint pulse, weak Qi, and only cold without heat. Reversal coldness from latent fire reveals slight heat signs after the cold episode, dry mouth without thirst, normal stool consistency, turbid urine, heart pain with burning sensation, restlessness, aversion to light preferring darkness, thirst with desire to drink, and hematemesis or epistaxis occurring with reversal coldness, all showing true heat and false cold signs. Initially use Qing Hua Tang (Clearing Transformation Decoction) combined with Sheng Jiang San (Ascending-Descending Powder) to attack latent heat, or Dang Gui Lu Hui Wan (Aloes Pill with Angelica). Subsequently use Wu Zheng Tang (Five Steaming Decoction) to clear heat. If reversal coldness stops but fever persists, use Da Bu Yin Wan (Great Tonify Yin Pill) and Di Huang Tang (Rehmannia Decoction) to nourish Yin. Another type of reversal coldness involves external cold blocking the exterior, preventing fire from venting; treat with Zhang Zhongjing's Si Ni San (Four Reversal Powder) added with Jingjie (Schizonepeta), Huanglian (Coptis), and Ku Qin (Scutellaria). If Yang Qi is determined to be sunken internally and unable to emerge, use Bai Tou Weng Tang (Pulsatilla Decoction) to clear and unblock, or Sheng Yang San Huo Tang (Raise Yang Scatter Fire Decoction) to warm and vent. Choose between these two formulas based on the situation.

Patients with blood disorders experiencing fever often present true heat and false cold, but true cold cases also exist. Excessive blood loss causes Qi to escape with the blood, leading to deficient and weak Middle Qi, and damaged insufficient Yuan Qi. Symptoms include coldness of the four limbs, anorexia, and loose stools. This is a cold syndrome generated by deficiency. The treatment method should be warming and tonifying. Use Shi Quan Da Bu Tang (Comprehensive Great Tonification Decoction), Shen Fu Tang (Ginseng and Aconite Decoction), or Yang Rong Tang (Nourish Blood Decoction) as appropriate.