Do you know anyone like this? In the sweltering heat of summer, while others are blasting the air conditioner and complaining about the heat, this person is bundled up in a thin jacket, their hands and feet feeling like ice blocks. And when winter comes, it’s even worse—even after two hours under the covers, their feet stay as cold as if they were clutching ice, and no amount of warming seems to help.

Logically, this sounds like yang deficiency, right? But after taking yang-tonifying herbs like Guifu Dihuang, there's little to no effect. Some people even experience symptoms of internal heat. So, what’s really going on?

Actually, this may not be caused by yang deficiency—the issue could stem from liver qi stagnation. According to traditional Chinese medicine, the liver governs free flow. When the liver is congested, yang qi is like blocked water flow, unable to reach the hands and feet smoothly, leaving the limbs naturally cold. Think about it: there’s clearly enough yang qi, but the passage is blocked. In this situation, further supplementing yang is like pouring water into a clogged pipe—no wonder there’s overflow and symptoms of excess heat.

So how can you tell if you have liver congestion? Just stick out your tongue and take a look. If both sides of the tongue appear noticeably swollen, it’s likely due to liver qi stagnation. Those who often hold in their anger or get easily irritated over minor issues may also experience liver wood overacting on spleen earth—there might be cracks in the middle of the tongue, a central indentation, and symptoms like bloating after eating, loss of appetite, and a feeling of heaviness in the body, which are signs of spleen deficiency and phlegm-dampness.

In such cases, instead of rushing to supplement yang, it’s important to first soothe the liver and relieve stagnation while regulating the spleen and stomach. You can consider using Si Ni San (Frigid Extremities Powder) with modifications. This formula is very simple, consisting of just four herbs: Zhishi (Citrus aurantium immature fruit), Chaihu (Bupleurum root), Shaoyao (Peony root), and Gancao (Licorice root).

Here, Chaihu works like a plumber, smoothing out congested liver qi and helping yang qi ascend. Shaoyao is a master at nourishing the liver, replenishing liver blood; paired with Chaihu, it ensures smooth liver qi and sufficient blood. Zhishi clears heat and disperses stagnated qi. Adding Gancao (Licorice) harmonizes the other herbs and supports spleen function.

This article is intended for educational purposes only. In summary, cold hands and feet are not necessarily due to yang deficiency—they could also be caused by liver stagnation. Health issues should be assessed through pattern differentiation; never take medication blindly. If you experience similar symptoms, consult a professional TCM practitioner for a targeted and reliable treatment plan.