Library

In the original prescription, add Shengma (Rhizoma Cimicifugae). In this formula, add Gegen (Puerariae Lobatae Radix) and Gancao (Glycyrrhizae Radix et Rhizoma) to resolve the macules. Add a small amount of Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria) to remove dampness and promote urination. Use Renshen (Ginseng Radix), Huoxiang (Agastaches Herba), and Muxiang (Aucklandiae Radix) to harmonize the spleen and stomach and promote food intake. Cut the herbs into pieces, take one liang (approx. 30-50g depending on historical context, here kept as unit), decoct in water, and take orally. After repeated administration, the macules recede, diarrhea stops, the body becomes warm, and consciousness returns. Subsequently, administer Yigong San (Five-Efficacy Powder) or Zhizhong Tang (Regulate the Middle Decoction), which are acrid-warm preparations, for one to two doses. Recovery can be expected within five days, at which point medication should be stopped. Someone asked: Although the illness has slightly improved, is it permissible to stop medication? I replied: Medications are used to attack pathogens. The *Neijing* states that treatment aims for balance. Once the pathogenic factor is eliminated, forcing further medication may lead to transformation of symptoms. It is better to rely on dietary nourishment and wait for the healthy qi to recover. This is the principle of "treating without medicine" and "curing without intervention." Within ten days, natural recovery will occur. (One must carefully examine cases where purgation is appropriate; Qianfu believed that at the current stage, purgation is suitable.)

Huo's commentary: If a patient presents with alternating chills and fever accompanied by cold extremities, lackluster complexion, dizziness, and sudden absence of pulse in both hands, or only one hand, positive sweating is certain to occur. Wrap the hands and feet in cotton clothing to keep them warm, and urgently administer Wuweizi Tang (Schisandra Decoction). Alternatively, administer formulas such as Mahuang Xixin Gancao Tang (Ephedra, Asarum, and Licorice Decoction). At this time, profuse sweating will likely occur, leading to resolution of the disease.

Wuweizi Tang: Treats cold damage presenting with panting, rapid breathing, hidden pulse, and cold extremities.
Ingredients: Renshen (Ginseng Radix), Maidong (Ophiopogonis Tuber, heart removed), Xingren (Armeniacae Semen Amarum, skin and tip removed), Shengjiang (Zingiberis Rhizoma Recens), Chenpi (Citri Reticulatae Pericarpium) (each 2.5 qian); Dazao (Jujubae Fructus) (two fruits); Wuweizi (Schisandrae Chinensis Fructus) (0.5 liang). Cut the herbs, decoct in water, and take orally.

Dai's commentary: Disorders of yin and yang can both cause jue (cold extremities/loss of consciousness). Thus, there are Yang Jue and Yin Jue, both indicating deep-seated disease. Among these two types of jue, Yang Jue is prone to misdiagnosis. One must inquire about the initial presentation. If upon onset, there was no headache, cold extremities, cramping of the legs, aversion to cold, spontaneous sweating with a desire to cover oneself, thirstlessness, loose stools with undigested food, or normal urination, and the patient remained alert and quiet, this is Cold Jue, belonging to Yin within Yin. Si Ni Tang (Frigid Extremities Decoction) or Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) are appropriate. If upon onset, there was headache and fever with other Yang syndrome signs, and jue developed after five to six days, and although the patient has cold extremities, they fear heat, desire water, toss their arms and legs, suffer from restlessness and insomnia, constipation, dark urine, and confusion, this is Heat Jue, belonging to Yang within Yin. Bai Hu Tang (White Tiger Decoction) or Da Cheng Qi Tang (Great Order the Qi Decoction) are appropriate. In Heat Jue, although the hands and feet are cold, the fingernails remain warm, unlike Cold Jue where even the nails are cold. This is a key method for distinguishing yin and yang. Recently, some patients with Yang diseases have had extreme heat above the waist and constant cold in the feet. This is because the Three Yin meridians do not ascend to the head, hence no headache; the Three Yang meridians do not descend to the feet, hence cold feet. Zhang Zhongjing stated that in cold damage, hands and feet are always slightly cold; if they are naturally warm, it belongs to Taiyin. This explanation is unclear. How could Yangming present with slightly cold hands and feet? Shaoyin and Jueyin present with severely cold hands and feet, how can it be called "slightly cold"? It should be stated that among the Three Yin meridians, Shaoyin and Jueyin present with cold extremities, while only Taiyin presents with naturally warm hands and feet.

Tao's commentary: A mistake in treating either Yin or Yang Jue leads to immediate death or life. Yang Jue originates from the Qi level of the Three Yang meridians due to cold pathogen invasion, starting with headache, fever, and aversion to cold, then transmitting to the Blood level of the Three Yin meridians, manifesting as Si Ni (Frigid Extremities) or Jue Ni (Reversal Cold). Symptoms include intermittent warmth, dry hard stool, delirium, thirst, tossing limbs, aversion to heat rather than cold, abdominal pain with tenesmus, sticky diarrhea, dark scanty urine, and a deep, forceful pulse. This indicates transmitted heat syndrome, termed Yang Jue. Extreme Yang causing Jue means Yang syndrome resembling Yin: externally cold extremities but internally hot pathogen. This is often due to unrelieved constipation causing stagnation of Qi and Blood, resulting in hands that are warm yet intermittently cold. Just as fire smelting gold turns it to water when heat is extreme, and water freezing turns to ice when cold is extreme. Mild Jue implies mild heat; deep Jue implies deep heat. Si Ni San (Frigid Extremities Powder) or Da Cheng Qi Tang are indicated. Failure to understand this and administering hot medicines is like carrying firewood to save a fire. Yin Jue results from cold pathogen directly affecting the Blood level of the Three Yin meridians. Initial symptoms lack fever and headache but include aversion to cold, cold extremities extending beyond elbows and knees, curling up with clothes, thirstlessness, possibly abdominal pain, vomiting, diarrhea, clear urine, shivering, pale face, salivation, and deep, slow, weak pulse. This is True Cold directly entering the Yin meridians, not transmitting from Yang, termed Yin Jue. Mild cases use Lizhong Tang; severe cases use Si Ni Tang. Also, diseases transmitting from Yang meridians but presenting as Yin syndromes with Jue are also Yin Jue. Furthermore, hands and feet are the extremities of Stomach Earth. Heat in Spleen/Stomach causes hot hands/feet; cold causes cold hands/feet. This is the norm. However, extreme excess may transform into mixed patterns, which is the variation. Scholars must study this diligently.

Wu's commentary: Generally, in cold damage, Jue indicates extreme depletion of Healthy Qi, requiring urgent treatment. Yang Jue usually results from unresolved intense heat. Liu Hejian stated that cold extremities with heat only in the chest and heart, combined with constipation, should be treated with Liang Ge San (Cool the Pagoda Powder) to nourish Yin and retreat Yang, avoiding rapid purgation. If stool is not constipated, Huanglian Jiedu Tang (Coptis Detoxification Decoction) is primary. For Jue syndromes treatable by purgation, dry feces exist in the interior. Palpating the umbilical area revealing hardness, fullness, or pain indicates dry feces. Passing foul-smelling gas or periumbilical stabbing pain also indicates dry feces. Mild cases use Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction); severe cases use Da Cheng Qi Tang. Alternatively, dissolve Yuanyanfen (Sodium Sulfate) in cool water (1-2 qian). Or mix chicken white with honey and water, adding Mangxiao (Natrii Sulfas) powder (2-3 qian) for best effect. Yang Jue is distinguished by a slippery pulse. Yin Jue results from Kidney Qi deficiency and cold, external cold exposure, mistaken use of cold medicines, or erroneous purgation, leading to accumulation of Yin at the lower jiao and decline of Yang at the upper jiao. Pulse is deep, fine, and faint, disappearing under pressure. Si Ni Tang should be administered urgently to warm. Severe cold follows the protocol for Yin Du (Yin Toxin). Shi Jue (Corpse Jue) is described in the classics: Shaoyin pulse is absent, Kidney Qi is weak, Jing and Blood are deficient, rushing Qi is urgent, Zong Qi gathers, Blood knots below the Heart, Yang Qi retreats downward, Heat returns to the inner thighs, interacting with Yin, causing insensibility. This is Shi Jue. Urgently puncture Qimen (LR14) and Juque (CV14). Bian Que cured the Crown Prince of Guo of Shi Jue by puncturing Sanyang Wuhui (GV20). This occurs because Yang meridians sink, Yin meridians rise, Zong Qi stagnates, Upper Jiao has severed Yang collaterals, Lower Jiao has broken Yin ties, disrupting pulses, causing stillness, cold, coma resembling death. Seek treatment principles from Yin Du protocols. In cold damage with chills/fever, Jue, lackluster face, dizziness, absent pulse(s), impending positive sweating resembles rain after drought. Wrap feet/hands in cotton, urgently give Wuweizi Tang, or combine with Guizhi Mahuang Banxia Tang (Cinnamon Twig, Ephedra, and Pinellia Half-Dose Decoction) to induce sweat. If pulse is absent and no sweat occurs, death ensues.

Acupuncture: Treat cold damage with cold extremities: Dadu (SP2) (1 fen moxibustion).
Cold damage with all six pulses absent: Fuliou (KI7) (Tonify to restore pulses), Hegu (LI4), Zhongji (CV3), Zhigou (TE6) (1.5 cun, this point harmonizes absent pulses), Fuliou (KI7) (down along bone), Juque (CV14) (3.3 cun), Qichong (ST30) (moxa 7 cones).
Shi Jue: Shaoyin pulse absent, Kidney Qi weak, Jing/Blood deficient, rushing Qi urgent, ascending to chest/diaphragm, Ying Qi gathers, Blood knots below Heart, Yang retreats, Heat returns to inner thighs, interacting with Yin causing insensibility. Puncture Qimen (LR14).