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Ni (Reversal) refers to the limbs being cold and not warm; Jue (Coldness) refers to extreme cold, which is more severe than Ni. The limbs are the root of all Yang meridians and should normally be warm and comfortable. If the fingertips are slightly cold, it indicates a deficiency of Yang Qi (Yang Qi originates from the tips of the ten toes); if the soles of the feet are cold, it indicates an excess of Yin Qi (Yin meridians converge at the soles of the feet and tend toward the sole center).

If the sores were originally scorched black, accompanied by irritability, thirst, sudden drowsiness, rapid breathing, and limb reversal/coldness, this is due to Yang toxin sinking inward, with heat qi stagnating and suppressing, causing the hands and feet to become cold. This is what is called "the deeper the heat, the deeper the Jue," or fire reaching its extreme resembling water.

If the sores were originally grayish-white, accompanied by diarrhea and dysentery and limb reversal/coldness, this is due to the exhaustion of Yuan Qi (Original Qi), where Yin and Yang Qi fail to connect smoothly, causing the hands and feet to become cold. In the manifestations of sores/rashes, the head usually desires coolness, while the feet usually desire warmth. Therefore, if the head is warm but the feet are cold, it is considered incurable. Limb reversal/coldness is a malignant syndrome in patients with sores.

If the Jue is caused by deep-seated heat, accompanied by constipation, San Yi Cheng Qi Tang (Three-Yi Purgative Decoction) is the primary prescription (indicated for abdominal fullness and constipation). If the sores are black, Bai Xiang Wan (Hundred-Auspicious Pills) or Niu Li Gao (Ox Plum Paste) are indicated (both seen in Black Sunken Syndrome). If the Jue is caused by diarrhea/dysentery and Qi deficiency, Chen Shi Mu Xiang San (Chen's Costus Powder) (indicated for diarrhea) or Yi Gong San (Benefit the Work Powder) (indicated for poor eruption) are indicated. If only the ten fingertips are slightly cold, Si Jun Zi Tang (Four Gentlemen Decoction) (indicated for inability to eat) or Li Zhong Tang (Regulate the Middle Decoction) (indicated for vomiting and diarrhea) combined with Gui Zhi (Cinnamon Twig) are indicated.

When fever occurs with smallpox, the hands and feet should remain warm and comfortable. Although it is often said that the feet belong to the Kidney and should be cool, here "cool" does not mean "cold." It means they are the same as those of a healthy person: the whole body is hot, but the feet are no different from normal, hence termed "cool." This also implies warmth and comfort, not true coldness. If the hands and feet are cold, it is because the patient previously suffered from frequent vomiting and diarrhea, leading to Spleen deficiency and weakness. Since the Spleen governs the four limbs, coldness results. Coldness is a malignant sign; one must not use exterior-releasing methods alone, as this would further damage the Spleen and Stomach. One should combine methods to harmonize the middle and release the exterior. The treatment of smallpox focuses on the Spleen and Stomach; therefore, one should urgently administer decoctions containing Atractylodes Macrocephala Rhizome (Baizhu) for drinking, avoiding procrastination and empty talk. First, use Huang Jian Zhong Tang (Yellow Regulate the Middle Decoction) (indicated for abdominal pain) added with Fang Feng (Saposhnikovia Root) and Qiang Huo (Notopterygium Rhizome), or Si Jun Zi Tang (Four Gentlemen Decoction) added with Huang Qi (Astragalus Root), Gui Zhi (Cinnamon Twig), and Fang Feng (Saposhnikovia Root) to release the exterior. After releasing the exterior, use Si Jun Zi Tang (Four Gentlemen Decoction) added with Huang Qi (Astragalus Root), Bai Shao Yao (White Peony Root), Dang Gui (Angelica Sinensis Root), and Gui Xin (Cinnamon Heart) to tonify the Spleen and Stomach, nourish Qi and Blood, and assist in the maturation of the smallpox lesions.

If the sores have just erupted and the hands and feet are already cold, it indicates the patient previously had vomiting and diarrhea. The Qi and Blood of the four limbs are derived from Stomach Qi; if Spleen and Stomach Qi are weak, it cannot reach the meridians. Li Zhong Tang (Regulate the Middle Decoction) added with Gui Zhi (Cinnamon Twig) is indicated.

Shen Fu Tang (Ginseng and Aconite Decoction): Treats Yang Qi deficiency and coldness in smallpox/rashes, characterized by teeth chattering, shivering, cold hands and feet, or vomiting/diarrhea with anorexia, and drinking boiling water without feeling heat. Use Du Shen Tang (Single Ginseng Decoction) added with high-quality genuine Fu Zi (Aconite Lateral Root), prepared according to standard methods. Start each dose with 1 qian; if there is no response, increase the dosage. If still ineffective, increase to 4-5 qian, or use equal parts, which is also acceptable. The purpose is to circulate Yang Qi. If Yang Qi has already collapsed, it is incurable.

Er Shen San (Two Deities Powder): Temporarily used for injury by cold and constitutional coldness, presenting with cold limbs, abdominal pain, cold breath, and difficulty in eruption and strengthening of the rash.
Ingredients: Ding Xiang (Caryophylli Flos) (9 grains), Gan Jiang (Zingiberis Rhizoma Recens/Prepared) (1 qian, roasted).
Grind the above into powder. Take 0.5 fen per dose, washed down with warm water. Cover with a blanket for a period of time to warm the Spleen and Stomach, causing Yin to retreat and Yang to return, thus transforming the smallpox into a favorable course. Adjust the dose according to the child's age and severity.