Interior Cold

Moxibustion is the primary modality: For Interior Cold, moxibustion is generally more important than needling. The Ling Shu states that conditions caused by Cold and blood stagnation should be treated with moxibustion. Direct moxa, indirect moxa (ginger-separated or salt-separated over Shenque REN-8), moxa boxes over the abdomen, and warming needle technique are all appropriate. Moxa cones or moxa rolls applied to Zhongwan REN-12, Guanyuan REN-4, Qihai REN-6, and Zusanli ST-36 form the core warming prescription.

Needling technique: Use reinforcing method (bu fa) on all points. Retain needles for 20-30 minutes. Warming needle (placing moxa on the needle handle) at Zusanli ST-36 and Guanyuan REN-4 combines the benefits of both acupuncture and moxibustion. Avoid reducing technique, as this would further deplete Yang.

Point combination rationale: The combination of Zhongwan REN-12 + Zusanli ST-36 + Pishu BL-20 (the Mu-Shu-He point triad for the Spleen/Stomach) is the foundational prescription for Middle Jiao Cold. For Lower Jiao Cold, use Guanyuan REN-4 + Shenshu BL-23 + Mingmen DU-4. For acute Yang collapse, salt-separated moxa at Shenque REN-8 combined with Guanyuan REN-4 and Qihai REN-6 is the classical emergency approach. Adding Baihui DU-20 with moxa can raise sinking Yang.

Ear acupuncture: Spleen, Stomach, Kidney, Shenmen, and Sympathetic points can supplement body acupuncture. Press seeds (Wang Bu Liu Xing seeds) can be retained between treatments for ongoing stimulation.

Distinguish Excess Cold from Deficiency Cold: This is the single most important clinical distinction within Interior Cold. Excess Cold (shi han) produces acute, severe, fixed pain that is worse with pressure (ju an), a full or tight pulse, and thick white tongue coating. Deficiency Cold (xu han) produces dull, lingering discomfort that improves with pressure (xi an), a weak or deep slow pulse, and a pale tongue with thin white coating. The treatment principle differs significantly: Excess Cold requires dispersing and expelling the pathogen, while Deficiency Cold requires warming and tonifying Yang. Using strong warming-and-dispersing herbs (like Ma Huang with Fu Zi) for pure Deficiency Cold can scatter what little Yang remains.

Check the tongue moisture carefully: In Interior Cold, the tongue should be moist or wet. A dry tongue in the presence of cold symptoms suggests either a false cold pattern (true Heat with false Cold), Yin Deficiency producing internal Heat, or a complex mixed pattern. Never assume Interior Cold if the tongue is dry and red.

Beware 'true Cold, false Heat' presentations: Severely depleted Yang can paradoxically produce floating Heat signs such as a flushed face, restlessness, or thirst. The key differentiator is that such patients want to drink warm (not cold) fluids, the flush is often only on the cheeks (dai yang, 'wearing Yang'), and the lower body and extremities are cold. The pulse is deep and faint at the root position despite surface agitation. Mistaking this for true Heat and prescribing cooling herbs can be dangerous.

Moxibustion over acupuncture: For Interior Cold, moxibustion is generally the superior modality. The classical texts are clear that Cold conditions benefit most from the warming nature of moxa. Needling alone in severe Yang Deficiency can actually further disperse Qi. When needling, always use reinforcing technique and consider warming needle method. Salt-separated moxa at Shenque REN-8 remains one of the most powerful interventions for acute Interior Cold and Yang collapse.

Protect the Middle Jiao first: Even when treating Lower Jiao Cold (Kidney Yang Deficiency), ensure the Middle Jiao (Spleen/Stomach) can absorb and utilise warming herbs. A severely weakened Spleen may not tolerate rich tonics like Shu Di Huang or heavy doses of Fu Zi. Start with easily digestible warming formulas (like Li Zhong Wan) before progressing to more powerful Kidney Yang tonics.