Case introduction Cai ××, male, 19 years old, Zhejiang. 2008-5-13 admission, hospitalization number: 8033XX. Since the age of 3, the patient developed burning heat on the soles of both feet, especially during activities or hot weather in spring and summer, and because he was young, he did not like to wear shoes and socks for a long time and needed to be barefoot. The symptoms gradually worsened as the heat sensation on the soles of the feet increased and progressed upward, and the lower legs also burned and swollen, accompanied by pain, with a color like paint, worse at night, aggravated by activities or emotional changes, requiring immersion in cold water or blowing air conditioners or fans to relieve, and in the most severe cases, requiring immersion in ice water once every half hour. He was diagnosed as “erythema limb pain” after undergoing vascular ultrasound and electromyography examination of both lower extremities, and was treated with various Chinese and Western medicines, most of which were used to clear heat and cool blood, resolve blood stasis and open blood vessels. A year ago, he developed redness and burning in both hands and ears. He was admitted to the hospital with the following symptoms: he was clear, thin, mentally exhausted, cold (body temperature did not rise, 35.6-36.3℃), redness and swelling of both lower limbs, extending above the knees, and he felt unbearable burning, especially at night, and needed to be immersed in ice-cold water from time to time, with a purple complexion after immersion. Due to long-term immersion in water, some of the ulcers, dry skin, multiple scratches, thickened toenails, poor appetite, dry mouth and desire to drink, normal bowel movements, dark red tongue, fat body, side teeth marks, sunken and weak pulse. Traditional Chinese medicine diagnosis: deficiency of spleen and kidney yang, yin and cold, compelling yang to sink, and stagnation of veins. Treatment: strengthening the spleen and tonifying the kidney, warming yang and dispersing cold, promoting yang through the veins. 7 doses with water decoction. The second diagnosis (2008-5-19): take the medicine for a week, the condition improved, the burning pain in the lower extremities slightly reduced, no need for ice water, to cold water soaking can be, soaking time reduced, redness and pain parts downward subside, still food and poor, the remaining no significant changes, tongue and pulse as usual, the above continued to take. Increase dry ginger to 20g, add cardamom 10g to warm the middle Jiao, aromatic wake up the spleen. Third diagnosis (2008-5-23): further improvement of the disease, body temperature gradually rise, lower extremity symptoms relief, redness, swelling, burning and other symptoms continue to recede, food and nourishment has been significantly improved, tongue and pulse as before, the effect is not more prescription, the above slightly add reduction: 20g of ripe fenugreek (first decoction), 15g of dried ginger, 20g of roasted licorice, 15g of Atractylodes, 30g of Radix Codonopsis, 15g of angelica, 1.5g of cinnamon (bubble), 15g each of red and white peony, Tongcao After the above treatment, the patient’s burning pain in the lower extremities was significantly reduced, the swelling gradually subsided, the redness of the skin faded to the ankle joint, the bowel movements were normal, the tongue was dark red, the moss was small, the pulse was sunken and thin, it was Yang Qi coming back, the original formula was poured to remove the warming products and add a little The original prescription was modified by removing the warming products and adding a little bit of Qi to nourish Yin, and the patient was discharged from the hospital for outpatient treatment. Erythromelalgia is a rare autonomic nervous system disorder characterized by paroxysmal vasodilatation of the distal limbs, increased skin temperature, redness of the skin and severe burning pain. Modern medicine believes that it is mainly related to the dilatation of the distal limb vessels, the involvement of peripheral sympathetic nerves and the dysfunction of vascular endothelial cells. The clinical manifestations are redness of the toes, soles, fingers and palms, increased arterial pulsation, and elevated skin temperature with unbearable burning pain. The pain is most often episodic or worse at night and usually lasts for several hours. The pain may be relieved by rest, elevation of the affected limb, exposure to cold air or immersion in cold water. Treatment mainly uses drugs to regulate the function of plant nerves, antipyretic and analgesic, sedative and hypnotic, and hormone treatment, which are unstable and have large side effects. Surgical treatment also includes intra-sacral nerve block and lumbar sympathetic nerve block, as well as sympathectomy or local neurectomy. Erythema limb pain belongs to the category of “heat paralysis” and “blood stasis” in Chinese medicine, and is treated clinically by activating blood, clearing heat, detoxifying and cooling blood. In this case, the patient had a long course of illness starting at a young age, with recurrent attacks and progressive aggravation. During the attack, the redness, swelling, heat and pain of the extremities were obvious, and the long-term and large amount of herbal treatment to clear heat and detoxify the blood injured the yang energy of the body. When he was admitted to the hospital, he appeared to have a feverish appearance, but after careful examination of the four diagnoses, he was really cold and falsely hot, as pointed out in Article 11 of the Treatise on Typhoid Fever: “If the patient has a great fever and wants to get close to the clothes, the fever is in the skin and the cold is in the bone marrow; if the patient has a great fever and does not want to get close to the clothes, the cold is in the skin and the heat is in the bone marrow”. False images appear mostly on the surface of the body (skin and face) and the limbs, and the manifestations of false images are mostly self-contradictory. “Good diagnostician, check the color and pulse, first distinguish between yin and yang.” Therefore, the diagnosis and treatment do not follow the normal method, and the treatment seeks the root of the disease, identifying the evidence as spleen and kidney yang deficiency, yin and cold within, forcing yang down, and stagnation of the ligaments and veins, forming the formula by strengthening the spleen and tonifying the kidneys, warming yang and dispersing cold, and opening the veins and raising yang.