《伤寒论》有先发热后发厥之阳厥，又有初起不发热即见逆冷之阴厥，此人人知之也。至发
热之症，表邪内伏，上身热而两足独冷。 痧内伏，上身热而呕吐足冷，即身热多汗，脉见沉
数，口舌生苔而两足独冷，此前书未有。不知寒邪初伤，未曾发热，乃有足冷。若上身发
热，则一人之身，岂有两足独冷之理。且冬寒之时，无病患常有足冷。若伤寒已经发热，即
冬月手足亦应温热。若两足尚冷，即为表邪未伸，热邪未得发越。况热令之时，人之手足皆
暖，岂有上身发热，两足反见独冷乎！家秘用羌独败毒散解表，以足冷之表邪，惟独活可解
耳。若失用独活，虽用发表，下部之邪终不散，重则变症，轻则缠绵，即令愈后，恐防痿痹
绝足。故凡汗出而身热不解者，非里热即表邪。若里有结热而发热不凉，必是遍身时时有
汗。若身大热而烦躁足冷，断非里热，必是表邪未散，或 痧未出。若是热深厥深之里热
症，必然遍身皆冷。今身热而足独冷，必是表症未解。故凡烦闷喘呕，身热足冷，便是发
之候。余治热令之热病，无论有汗无汗，脉浮脉沉，一见身热足冷，乃改常之重症，故从症
不从脉者，如是治法，或有汗出而愈者。或先有寒凉抑遏，一汗不能全解，连作三四次汗而
愈者。惟 毒久遏，凶多吉少。然 色鲜明，亦有不死。惟荤腥食重，抑遏 痧表汗者，多
不能生。常见夏秋热症之人，内有积热，外冒表邪，又被饮食寒凉抑遏胃阳，阳明邪热不得
发越，但头汗遍身无汗。又有 痧疫毒，抑遏胃阳，亦不能宣扬外发。余常以枳壳、浓朴、
广皮三味松发胃气，又以柴胡、葛根、防风三味宣散表邪，有表邪者汗必出，有 毒者 亦
现。因此悟得但头有汗，遍身无汗之症，方书以水饮、蓄血、中焦不得宣通主治。例如湿邪
凝结，用苍术、浓朴、葛根、防风。寒邪凝结，用生姜、羌活。热邪凝结，用黄连、枳壳。
食积凝结，用麦芽、豆蔻。痰饮凝结，用半夏、石菖蒲。要知枳壳、豆蔻、香附、砂仁，为
胸前之总司，葛根、升麻，乃宣扬胃气，手足温暖，遍身热越，汗出表解，故宣扬胃气，乃
发汗之妙法也。按足冷与面赤皆系表邪，然面赤色在上部，人人知之。足冷在下部，人多忽
之，故余特补着。然治足冷，互参发 、夹食治法，故升麻解表汤，家秘通用者。
独活汤
独活 防风 柴胡 葛根 广皮 甘草
身痛，加羌活；胸满，加枳壳；呕恶，加半夏、浓朴、白豆蔻、川黄连。
和胃透肌汤
浓朴 枳壳 广皮 柴胡 葛根 防风
足冷皆系表邪，但未明表汗 痧，故立一举两得之方。
升麻解表汤 见夹食。
《伤寒论》中记载有先发热后出现四肢厥冷的阳厥，又有初起不发热即见四肢逆冷的阴厥，这是人人都知道的。至于发热病症中，表邪内伏，上身热而两脚唯独寒冷；痧毒内伏，上身热且呕吐、脚冷；即使身体发热多汗，脉象沉数，口舌生苔而两脚唯独寒冷，这些是前代医书未曾记载的。不知道寒邪初伤人体时，尚未发热，才会有脚冷。如果上身已经发热，那么一个人的身体，怎么会有两脚唯独寒冷的道理呢？况且在冬季严寒之时，没有生病的人也常有脚冷的情况。如果患伤寒已经发热，即使在冬天，手脚也应该温热。如果两脚仍然寒冷，就是表邪未能舒展，热邪未能发散透达。何况在炎热季节，人的手脚都是温暖的，怎么会有上身发热，两脚反而唯独寒冷呢！家父（作者自称）秘传的方子用羌活、独活败毒散来解表，因为对于足冷的表邪，只有独活才能解除。如果漏用了独活，虽然使用了发表药，下部的邪气终究不能消散，重的会变为变证，轻的则缠绵难愈，即使后来痊愈了，恐怕也要预防痿痹或足部断绝生机。所以凡是出汗但身热不退的，不是里热就是表邪未解。如果里有结聚之热而发热且不觉凉，一定是全身时时都有汗。如果身体大热且烦躁、脚冷，绝对不是里热，一定是表邪未散，或者痧毒未出。如果是热深厥深的里热症，必然全身都冷。现在身体热而脚唯独冷，一定是表证未解。所以凡是烦闷气喘呕吐，身热脚冷，就是发痧的征兆。我治疗炎热季节的热病，无论有汗无汗，脉浮脉沉，一见身热脚冷，这是反常的重症，所以遵循“从症不从脉”的原则，这样治疗，有的出汗就好了。有的先前被寒凉药物抑制遏阻，一次发汗不能完全解除，连续发三四次汗才好的。只有痧毒久被遏阻，凶多吉少。然而痧色鲜明，也有不死的情况。只有因吃荤腥油腻食物过重，抑制遏阻了痧毒和表汗的，大多不能存活。常见夏秋季节热病患者，体内有积热，外感表邪，又被饮食寒凉抑制遏阻胃阳，阳明邪热不得发散透达，仅头部出汗，遍身无汗。又有痧疫毒邪，抑制遏阻胃阳，也不能宣扬外发。我常用枳壳、厚朴、广陈皮三味药来疏通胃气，又用柴胡、葛根、防风三味药来宣散表邪，有表邪的一定会出汗，有痧毒的痧疹也会显现。因此悟出仅头部出汗、遍身无汗的病症，医书多以水饮、蓄血、中焦不得宣通来主治。例如湿邪凝结，用苍术、厚朴、葛根、防风。寒邪凝结，用生姜、羌活。热邪凝结，用黄连、枳壳。食积凝结，用麦芽、豆蔻。痰饮凝结，用半夏、石菖蒲。要知道枳壳、豆蔻、香附、砂仁，是胸前部位的总司（关键药物），葛根、升麻，乃宣扬胃气，使手足温暖，遍身热邪发散，出汗表解，所以宣扬胃气，乃是发汗的妙法。按：足冷与面赤都属于表邪，然而面赤颜色在上部，人人皆知。足冷在下部，人多忽略它，所以我特意补充论述。然而治疗足冷，需互参发痧、夹食的治疗方法，所以我秘传通用的方子是升麻解表汤。
独活汤
组成：独活、防风、柴胡、葛根、广陈皮、甘草。
加减：身痛，加羌活；胸满，加枳壳；呕恶，加半夏、厚朴、白豆蔻、川黄连。
和胃透肌汤
组成：厚朴、枳壳、广陈皮、柴胡、葛根、防风。
方解：足冷皆属于表邪，但未明确表汗和发痧，所以设立一举两得的方子。
升麻解表汤 见“夹食”章节。
The *Shanghan Lun* (Treatise on Cold Damage) records Yang Jue (Yang Reversal, a condition characterized by initial heat followed by cold extremities) where fever precedes the onset of cold limbs, and Yin Jue (Yin Reversal, a condition characterized by cold extremities without initial fever) where cold limbs appear at the onset without fever; this is known to everyone. However, in febrile conditions where exterior pathogens are internally trapped, there is heat in the upper body but only the feet are cold. When Sha (Sha disease/toxin, often referring to toxic heat or eruptive diseases) is internally trapped, there is heat in the upper body accompanied by vomiting and cold feet. Even if the body is hot with profuse sweating, the pulse is deep and rapid, the tongue has coating, yet only the feet are cold—these scenarios were not recorded in previous medical texts. It is unknown that when cold pathogen initially injures the body before fever occurs, cold feet may present. If the upper body is already hot, how could it be that within one person's body, only the two feet are exclusively cold? Moreover, during winter cold, even healthy people often have cold feet. If one has contracted Shanghan (Cold Damage) and already has fever, even in winter months, hands and feet should be warm. If the feet remain cold, it indicates that the exterior pathogen has not been extended/dispersed, and the heat pathogen has not been able to vent outward. Furthermore, during hot seasons, people's hands and feet are all warm; how could there be heat in the upper body while only the feet are cold? My family secret formula uses Qianghuo Duhuo Baidu San (Notopterygium and Angelica Pubescens Decoction for Resolving Exterior and Expelling Toxins) to resolve the exterior, because for the exterior pathogen causing cold feet, only Duhuo (Angelicae Pubescentis Radix) can resolve it. If Duhuo is omitted, although exterior-resolving herbs are used, the pathogen in the lower part will ultimately not disperse; severe cases will transform into complicated syndromes, mild cases will linger, and even if cured later, one must fear complications like Wei Bi (Atrophy Syndrome with Obstruction) or loss of vitality in the feet. Therefore, whenever sweating occurs but body heat does not resolve, it is either interior heat or unresolved exterior pathogen. If there is knotted heat in the interior causing fever without feeling cold, there must be sweat appearing intermittently over the whole body. If the body is very hot, restless, and feet are cold, it is definitely not interior heat, but rather unresolved exterior pathogen or un-erupted Sha toxin. If it were a case of "heat deep, reversal deep" (Re Shen Jue Shen), indicating interior heat syndrome, the entire body would necessarily be cold. Now, since the body is hot but only the feet are cold, it must be that the exterior syndrome is unresolved. Thus, whenever there is irritability, distension, panting, vomiting, body heat, and cold feet, these are signs of Sha eruption. In treating febrile diseases during hot seasons, regardless of whether there is sweating or not, and whether the pulse is floating or deep, once I see body heat with cold feet—a deviation from normal severe condition—I follow the principle of "treating based on symptoms rather than pulse." With such treatment, some recover after sweating. Some, previously suppressed by cold-cooling agents, require multiple rounds of sweating (three or four times) to fully resolve. Only when Sha toxin is long-suppressed is prognosis poor (more ominous than auspicious). However, if the Sha color is bright and clear, survival is possible. But if heavy consumption of meat/fish suppresses the Sha and exterior sweating, survival is unlikely. I commonly see patients in summer and autumn with internal accumulated heat and external exterior pathogen, whose Stomach Yang is further suppressed by cold dietary intake, preventing the Yangming heat pathogen from venting outward; they exhibit sweating only on the head with no sweating on the rest of the body. Similarly, Sha epidemic toxins suppressing Stomach Yang also fail to promote outward eruption. I frequently use Zhiqiao (Aurantii Fructus), Houpo (Magnoliae Officinalis Cortex), and Guangpi (Citri Reticulatae Pericarpium) to loosen and regulate Stomach Qi, and Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), and Fangfeng (Saposhnikoviae Radix) to disseminate exterior pathogens. Where there is an exterior pathogen, sweating will occur; where there is Sha toxin, Sha eruptions will manifest. From this, I realized that for conditions with sweating only on the head and none on the body, medical books treat them primarily as Water Retention, Blood Stasis, or failure of the Middle Jiao to circulate freely. For example: for dampness condensation, use Cangzhu (Atractylodis Rhizoma), Houpo, Gegen, Fangfeng; for cold condensation, use Shengjiang (Zingiberis Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix); for heat condensation, use Huanglian (Coptidis Rhizoma), Zhiqiao; for food stagnation condensation, use Maiya (Hordei Fructus Germinatus), Doukou (Amomi Fructus Rotundus); for phlegm-fluid condensation, use Banxia (Pinelliae Rhizoma), Shichangpu (Acori Tatarinowii Rhizoma). One must know that Zhiqiao, Doukou, Xiangfu (Cyperi Rhizoma), and Sharen (Amomi Fructus) are the key regulators for the chest area, while Gegen and Shengma (Cimicifugae Rhizoma) promote the dissemination of Stomach Qi, warming hands and feet, dispersing heat throughout the body, inducing sweating to resolve the exterior. Thus, promoting Stomach Qi dissemination is a subtle method for inducing sweating. Note: Both cold feet and red face belong to exterior pathogens. Red face appears in the upper part, which everyone knows. Cold feet appear in the lower part, which many ignore; hence I specifically supplement this discussion. However, treating cold feet requires referencing methods for Sha eruption and Food Stagnation. Therefore, my universally applied secret formula is Shengma Jiexiao Tang (Cimicifuga Exterior-Resolving Decoction).
Duhuo Tang (Angelica Pubescens Decoction)
Ingredients: Duhuo, Fangfeng, Chaihu, Gegen, Guangpi, Gancao.
Modifications: Add Qianghuo for body pain; add Zhiqiao for chest fullness; add Banxia, Houpo, Baiddoukou, and Chuanhuanglian for nausea/vomiting.
Hewei Touji Tang (Harmonize Stomach and Penetrate Muscle Decoction)
Ingredients: Houpo, Zhiqiao, Guangpi, Chaihu, Gegen, Fangfeng.
Explanation: Cold feet are all due to exterior pathogens, but the distinction between exterior sweating and Sha eruption was unclear; thus, this formula achieves two goals with one action.
Shengma Jiexiao Tang See entry under "Food Stagnation".