bubble_chart Concept

Fever with cold limbs refers to the simultaneous occurrence of both fever and cold limbs during the course of Rebing.

Suwen. Jue Lun once described "fever" and "cold hands and feet"; the "Cold-Damage Disease Treatise" records "the deeper the heat, the severer the reversal coldness" and "reversal cold of hands and feet is called jue," and treats fever with cold limbs as a main symptom for pattern differentiation and treatment. Later generations of physicians have all followed Zhongjing's theory.

Fever with cold limbs can be seen in the initial stage of external-contraction febrile disease [first stage], where the pathogenic wind-cold is constrained on the body surface, leading to a struggle between healthy qi and pathogenic qi. Fever begins to rise, and at this time, the limbs also feel cold, but this is temporary. As the fever intensifies, the limbs warm up, so this is not within the scope of this discussion. For more details, see the section on aversion to cold with fever.

bubble_chart Pattern Analysis

1. The Deeper the Heat, the Severer the Reversal Cold︰Persistent high fever, reversal cold of hands and feet, headache, chest tightness, flushed face and rough breathing, dysphoria with delirious speech, followed by unconsciousness, dark urine, red and dry crimson tongue texture, slippery and rapid or surging and rapid pulse. Mostly seen in the late stage [third stage] of external-contraction febrile disease, where external pathogens enter the interior and reverse-transmit to the pericardium; or caused by summerheat pathogens stagnating and blocking internally. Clinically, it may manifest as persistent high fever, headache, flushed face, dysphoria with rough breathing, unconsciousness and delirious speech, along with reversal cold of hands and feet. If summerheat invades internally, leading to qi depression and failure to disperse, symptoms include high fever, chest tightness, reversal cold of hands and feet, thirst, profuse sweating, scanty dark urine, and surging rapid pulse. The mechanism of disease is excessive pathogenic heat reversing transmission inward, failing to reach the exterior—the deeper the heat, the more severe the reversal coldness. For the former, treatment focuses on draining heat to relieve stagnation, clearing the heart and opening the orifices, using Nutrient-Clearing Decoction combined with Peaceful Palace Bovine Bezoar Pill or Purple Snow Bolus plus antelope horn, Uncaria, and Abalone Shell, etc. For the latter, treatment aims to clear summerheat and resolve heat, using White Tiger Decoction Plus Ginseng or Summerheat-Clearing Qi-Replenishing Decoction with modifications.
2. Exuberant Yin Repelling Yang︰Fever with a flushed face, dry and sore throat; reversal cold of hands and feet, diarrhea with undigested food, pale tongue with white coating, and deep thready pulse on the verge of collapse. Mostly seen in the late stage [third stage] of {|###|}external-contraction febrile disease{|###|}, caused by the misuse of diaphoresis, emesis, or purgation, leading to {|###|}yang qi{|###|} decline and {|###|}pudendal coldness{|###|} flourishing internally, repelling {|###|}yang{|###|} outward. Clinical manifestations include fever with dry throat, a flushed face as if wearing makeup but cold extremities, diarrhea with undigested food, and a faint, thready pulse on the verge of collapse. The {|###|}mechanism of disease{|###|} is {|###|}yang{|###|} decline and {|###|}yin exuberance{|###|}, with floating deficient {|###|}yang{|###|}. Treatment should focus on {|###|}warming yang{|###|} to rescue collapse, unblocking {|###|}yang{|###|} to restore the pulse, using the formula Vessel-Unblocking Cold-Extremities Decoction with modifications.

Although both of the above syndromes can be seen in the late stage [third stage] of external-contraction febrile disease, one is due to the inward invasion of warm-heat pathogens into the pericardium, where the pathogens are obstructed and cannot be expelled, leading to the deeper the heat, the severer the reversal coldness; the other is due to Rebing repeatedly undergoing sweating and purging, resulting in severe damage to yang qi, internal exuberance of yin, or the transmission of wind-cold pathogens into the three yin, with pudendal coldness and exuberant heat, leading to the rejection of deficient yang. Key points for differentiation: the former is characterized by high fever, cold limbs, unconsciousness, dysphoria, thirst, and rapid pulse, where heat is the root and cold is the branch; the latter is based on cold limbs, no aversion to cold, and a faint pulse on the verge of extinction, where cold is the root and heat is the branch. Clinically, it is essential to carefully examine the disease cause and mechanism of disease to avoid misdiagnosis.

bubble_chart Documentation

1. 《Treatise on Cold Damage Diseases · Differentiation and Treatment of Shaoyin Disease Pulse and Symptoms》: "Shaoyin disease, diarrhea with clear undigested food, interior cold with external heat, cold extremities, faint pulse on the verge of disappearing, the body does not show aversion to cold, the patient's face is red, or there is abdominal pain, or retching, or sore throat, or cessation of diarrhea with no pulse, Vessel-Unblocking Cold-Extremities Decoction is the main treatment."
2. Yizong Jinjian · Essential Formulas of the Heart Method for Cold Damage Diseases: "The external symptoms include a red face, fever, and irritability, resembling yang heat, but internally there is no thirst, diarrhea with clear undigested food, clear and pale urine, pale nails, cold limbs, a floating and faint pulse on the verge of disappearing, all signs of pudendal coldness deficiency pattern. It is appropriate to take Vessel-Unblocking Cold-Extremities Decoction cold, to restore yang from yin."