Many people frequently experience "hot" symptoms such as oral ulcers, sore throat, irritability, and insomnia, but taking clearing heat herbs does not work well and tends to recur. Upon closer questioning, they often also have "cold" manifestations like aversion to cold in the abdomen, loose and watery stools, and cool legs and lower back. This coexistence of "hot" and "cold" signs is known as "upper heat and lower cold" in Traditional Chinese Medicine, and the problem often lies in the middle jiao (stomach and spleen).

According to Traditional Chinese Medicine, the spleen and stomach serve as the pivotal hub of qi dynamics in the body. They govern transformation and transportation, and coordinate the upward and downward flow of qi. If spleen-stomach deficiency-cold occurs, leading to dysfunction of this hub, it results in stagnation of qi dynamics and a disruption between the upper and lower parts of the body. Consequently, yang qi fails to warm the lower body but becomes trapped above, generating deficiency fire. This manifests as the characteristic symptoms of "heat in the upper body and cold in the lower body."

For this condition, simply clearing heat may injure the spleen and stomach, while simply warming and tonifying may exacerbate fire. It is necessary to regulate both aspects. The Sage of Medicine Zhang Zhongjing has a concise formula in the *Treatise on Cold Damage*—Gan Jiang Zhi Zi Tang, which uses only two herbs, one clearing and one warming, working synergistically.

The formula includes:

Dried ginger: Warms the center, dispels cold, tonifies the spleen's yang, invigorates the spleen and stomach function, and clears the obstruction in the middle energizer at its root;

Gallberry: Clears floating fire in the upper energizer, promotes diuresis and eliminates dampness, guides excess heat downward, and resolves symptoms such as dry mouth, sore throat, restlessness, and insomnia ("upper heat" symptoms).

Two herbs are paired, neither aiding fire nor injuring yang, clearing the upper and warming the lower, working together to restore the balance of qi movement's ascending and descending.

【Real Case】

In the clinic, a Mr. Zheng, 38 years old, came in who had recurrent oral ulcers for half a year, accompanied by dry throat and insomnia, but had particularly cold abdomen and legs, with diarrhea after eating cold food. The tongue was pale with thin white coating, and the pulse was fine and weak. The syndrome differentiation was spleen and stomach deficiency-cold with floating deficiency-fire. The modified Zhi Zi Gan Jiang Decoction was prescribed: Zhi Zi 9g, Gan Jiang 6g, Bai Zhu 10g. After taking five doses, the oral ulcers largely disappeared, the coldness 减轻 ed, and sleep improved. Subsequently, treatment focused on strengthening the spleen and warming the middle for a month, with significant improvement in constitution.

It should be noted that this formula is suitable for those truly belonging to the "upper heat and lower cold" or "spleen and stomach deficiency-cold with floating deficiency-fire" pattern. If it is an excess-heat or damp-heat syndrome, with symptoms like bitter mouth, yellow greasy tongue, and constipation, it should not be used. It is recommended to use the formula under the guidance of a physician for syndrome differentiation and not to take it for a long term without prescription.