Library

Zhang Zhongjing stated: "When a patient's body is extremely hot, yet they desire to cover themselves with clothing, it indicates that the heat is in the skin (superficial level) and the cold is in the bone marrow (deep interior)." The *Huoren Shu* (Book of Vitality) states: "First administer Guizhi Tang (Cinnamon Twig Decoction) to treat the exterior cold, followed by Xiaochaihu Tang (Minor Bupleurum Decoction) to treat the interior heat." It further states: "When a patient's body is extremely cold, yet they do not desire to cover themselves with clothing, it indicates that the cold is in the skin and the heat is in the bone marrow." The *Huoren Shu* states: "First administer Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) to treat the interior heat, followed by Guizhi Mahuang Ge Ban Tang (Half-Size Decoction of Cinnamon Twig and Ephedra) to resolve the exterior pathogen."

The *Mai Jing* (Pulse Classic) states: "In febrile diseases, what is called 'Yang attaching to Yin' refers to heat from the waist down to the feet, and cold above the waist. If Yin Qi contends downward and results in fullness of the heart and abdomen, the prognosis is fatal." What is called 'Yin attaching to Yang' refers to heat from the waist up to the head, and cold below the waist. If Yin Qi contends upward and sweating occurs, the prognosis is favorable. The *Ling Shu Jing* (Spiritual Pivot) states: "For upper cold and lower heat, first needle the Taiyang acupoints on the neck, retain the needles for a long time; after needling, apply moxibustion or warming therapy to the neck and scapula until heat descends and merges, then stop. This is called 'pushing upwards' (propelling Yang Qi upward)." For upper heat and lower cold, observe the deficient pulses sinking into the collaterals and meridians for treatment; stop when the Qi descends. This is called 'drawing downwards' (guiding Heat downward)." Li Dongyuan stated: "There is another type of upper heat and lower cold. The classics state: 'Yin disease in the Yang aspect should be guided from Yang to Yin.' One must first remove blood stasis from the collaterals and main meridians. If Fire within Yin flares upward to the Heaven aspect, causing the Qi of the Six Yang channels to fail to decline and instead fill the upper body, one must first puncture the blood collaterals of the Five Zang organs to guide the Qi downward. When Heavenly Qi descends, the pathology of lower cold will naturally resolve. Do not solely purge the Six Yang channels. This condition involves Yang hyperactivity, nourished by Evil Yin Fire; only clear the Yin Fire and remove the evil from the blood collaterals and meridians. Do not err." The Sages consider upper heat and lower cold as having the qualities of Spring and Summer but lacking those of Autumn and Winter. One should guide Yang Qi downward from the Heaven aspect into the Earth aspect. In this syndrome, excessive Fire of Group Yin in Heaven assists the Six Yang Qi, preventing their decline. First, puncture the blood collaterals in the Six Yang channels to release blood, causing Qi to descend. Although the power of the Three Yin channels is weak, it can drive the Six Yang Qi downward because Yin Blood naturally descends. This can also be described as the transformation of Old Yang into Yin. Thus, the classics state: "For upper heat and lower cold, treat points where deficient pulses sink into the collaterals and meridians; this is called 'drawing downwards.'" Merely mentioning collaterals is sufficient. For severe cases, use a three-edged needle to release blood, removing Heat from the Yang aspect. The Heat here is the lingering Fire-Evil in the Hand-Taiyang Small Intestine channel, which prevents Old Yang from transforming into Yin and descending. Therefore, first puncture the Hand-Taiyang channel to release hot blood, allowing the Three Yin channels to function timely and descend, executing the Autumn function, obeying the Dao of收 (gathering), entering the Earth, and storing. This purges the Qi that remains in Heaven, refusing to transform and follow the Yin Dao. In the spring of Wuchen year of the Zhiyuan era, Yang Zhengqing, Vice Minister of Secretariat, aged over seventy, suffered from a face appearing congested and red, resembling drunkenness, with thick sticky phlegm, frequent dizziness, feeling as if in wind and fog. One day at the Departmental Hall, this syndrome suddenly appeared, accompanied by blurred vision, so he returned home. I examined his pulse: both Cun positions were surging and large, while Chi positions were wiry, thin, and powerless, clearly indicating upper heat and lower cold. I intended to prescribe medicine, but due to his advanced age and weak Qi, he could not tolerate it. Recalling my late master's discussion: "Upper heat is like a bird's nest high atop a peak; shoot it to retrieve it." I used a three-edged needle to prick rapidly more than twenty times at the anterior hairline, releasing about two he of dark purple-black blood. Immediately, the head and eyes felt clear and comfortable, all suffering vanished, and it did not recur thereafter. Yao Mao, Left Vice Director of the Secretariat, aged sixty-seven, had a chronic latent wind disorder. At the end of the Wushen year of the Zhiyuan era, triggered by alcohol consumption, his head and face became swollen, red, and painful, especially around the ears. He experienced chest oppression, throat discomfort, coldness in the lower half of the body, particularly the calves. Consequently, beds were joined to form a pit, and he lay mostly in the upper part. His diet decreased, spirit was fatigued, and body ached. I treated him and found the pulse floating and rapid, wiry and thin upon pressure, clearly indicating upper heat and lower cold. The *Nei Jing* (Inner Canon) states: "Excess heat causes swelling." It also says: "Spring Qi diseases affect the head." The *Nan Jing* (Classic of Difficult Issues) states: "Accumulation leads to swelling and heat; treat with bi-shooting (bloodletting)." Taking advantage of its ease to dissipate, I pricked more than fifty times on the swollen area, releasing about one cup of dark purple-black blood. Pain dissipated shortly after. I then applied heavy moxibustion (one hundred moxa cones) at Qihai (CV6) to assist Yang deficiency in the Lower Jiao and dispel Yin Cold. Next, I moxa-burned bilateral Zusanli (ST36) thirty-seven times each to treat coldness in the feet and guide Yang Qi downward. I then formulated a prescription named Jiji Jiedu Tang (Ji Ji Detoxifying Decoction), applying the principle of "treating heat with cold." However, diseases vary in height and depth, and treatments vary in distance; nothing exceeds these principles. Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) are bitter and cold, prepared with wine as a guiding agent to purge upper heat. Jiegeng (Platycodonis Radix) and Gancao (Glycyrrhizae Radix et Rhizoma) are acrid, sweet, and warm, ascending, assisting the bitter herbs to treat heat. Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma) are bitter and neutral, with light flavors, belonging to Yang within Yang, dispersing upper heat. Lianqiao (Forsythiae Fructus) is acrid, bitter, and neutral, resolving nodules and reducing swelling. Danggui (Angelicae Sinensis Radix) is acrid and warm, harmonizing blood and relieving pain. Wine-wrapped Dahuang (Rhei Radix et Rhizoma) is bitter and cold, guiding the bitter nature upward to relieve irritability and heat. After administration, swelling subsided, pain decreased, and bowel movements became smooth. Upon the second dose, reduce the amount of Dahuang. Advise caution in speech and moderation in diet. Within ten days, full recovery was achieved.