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When the pulse at both the Cun (inch) and Chi (cubit) positions is faint (Wei, weak/faint), it indicates that the Jueyin (Jueyin Meridian Disease) has been affected. This condition typically manifests on the sixth or seventh day of onset because the Jueyin meridian courses through the genitalia and connects with the Liver; therefore, symptoms include irritability, chest and hypochondriac fullness, and retraction of the scrotum. (If the pulse is faint and slow, the scrotum will certainly not retract. If external signs such as fever and aversion to cold resembling malaria are present, this is a sign of impending recovery, and Guizhi Mahuang Ge Ban Tang [Cinnamon Twig and Ephedra Half-Dose Decoction] should be used. If the pulses at both Cun and Chi are deep and short, the scrotum will certainly retract, and Chengqi Tang [Stomach-Clearing Decoction] should be used to purge the interior; see the "Purgative Patterns" chapter for the formula.)

The hallmark manifestations of Jueyin disease are: excessive thirst (Xiao Ke), Qi rushing up to the heart, pain and burning sensation in the heart region, hunger without desire to eat, vomiting of roundworms upon eating, and intractable diarrhea if purged inappropriately. Wumei Wan [Mume Pill] is the primary treatment.

In Shaoyang disease, if the pulse is faint and there is cold extremities (Jue), progressing to the seventh or eighth day with whole-body skin coldness and restlessness without respite, this is Zang Jue (Visceral Cold Reversal), not Hui Jue (Roundworm Reversal). Patients with Hui Jue typically vomit roundworms and exhibit alternating periods of quietness and irritability due to visceral cold. When roundworms ascend into the diaphragm, irritability occurs but subsides shortly after. Vomiting accompanied by renewed irritability after eating occurs because the worms emerge upon smelling food odor; these patients often spontaneously vomit roundworms. Hui Jue is treated with Wumei Wan. It is also used for chronic dysentery. (Zang Jue should be treated with Sini Tang [Frigid Extremities Decoction] category formulas, administered cold.)

Wumei (150 fruits), Ganjiang (Dried Ginger, 5 liang), Huanglian (Coptis Rhizome, 8 liang), Danggui (Angelica Sinensis Root, 2 liang), Chuanjiao (Sichuan Pepper), Guizhi (Cinnamon Twig), Fuzi (Prepared Aconite Root Lateralis), Renshen (Ginseng Root), Huangbai (Phellodendron Bark), Xixin (Asarum Root) (each 3 liang).

Grind each herb separately and sieve, then mix. Soak Wumei in vinegar overnight, remove pits, steam over two dou of rice until cooked, then pound into a paste. Mix with the herbal powders, place in a mortar, add honey, and pound two thousand times until uniform. Form pills the size of paulownia seeds. Take ten pills before meals with warm water, three times daily. Gradually increase to twenty pills. Avoid cold, slippery, and strong-smelling foods.

In Jueyin wind-stroke, a slightly floating pulse indicates impending recovery; a non-floating pulse indicates no recovery.

A slow pulse treated incorrectly with Huangqin Tang [Scutellaria Decoction] to clear heat should result in abdominal coldness and an inability to eat. If the patient suddenly regains the ability to eat, this is Chu Zhong (Elimination of the Middle/False Appetite), indicating certain death.

If cold extremities precede fever, diarrhea will cease spontaneously. However, if sweating and sore throat occur instead, Bi syndrome of the throat develops. If fever occurs without sweating and diarrhea ceases spontaneously, but persists, pus and blood will appear in the stool, and the throat will not be bi-blocked.

Pang Anshi states: Mild heat and slight cold extremities, with cold fingertips, silence, anorexia, and irritability lasting several days, with normal urination, indicates the elimination of heat. Ganjiang Gancao Tang [Dried Ginger and Licorice Decoction] is appropriate. (See "Taiyang Patterns" for the formula.)

Pang Anshi states: Cold reversal of the hands and feet belongs to Jueyin; purgatives and diaphoretics are contraindicated. However, if purgation is necessary, it refers to cases where hands and feet are cold but occasionally warm, or where palms and soles remain warm despite cold extremities; this is not true Jue, so diaphoresis or purgation may be considered cautiously.

In Shaoyang disease from day one or two to four or five, cold extremities must be followed by fever. Previous cold reversal is followed by subsequent fever; severe cold reversal corresponds to severe fever, and mild cold reversal to mild fever. If cold reversal does not exceed five days, and ceases on the sixth day, recovery is certain. If cold reversal persists on the sixth day, fever will intensify, accompanied by persistent diarrhea.

Pang Anshi states: In cases of alternating chills and fever with cold extremities, lusterless complexion, and dizziness, wrap the hands and feet in cotton cloth to keep them warm; profuse sweating will lead to resolution. Some cases do not resolve via profuse sweating but present with absent radial pulses in both hands, termed Shuang Fu (Double Hidden Pulse); or absent pulse in one hand, termed Dan Fu (Single Hidden Pulse). If diarrhea stops, normal sweating must follow; urgently administer Sini Tang [Frigid Extremities Decoction] category formulas to warm. If sweating occurs, the patient stabilizes. If the pulse never returns, death ensues.

In diarrhea, if cold extremities precede fever, diarrhea ceases spontaneously. Otherwise, sore throat or throat Bi occurs; if pus and blood appear in stool, the throat is not Bi-blocked.

In cold reversal with diarrhea, anorexia is expected. If the patient can eat, this is Chu Zhong, indicating certain death. If able to eat and febrile with a rapid pulse, carbuncles and abscesses will develop. In cold reversal with vomiting and chest/hypochondriac irritability, pus and blood will subsequently appear in the stool.

Patients with cold hands and feet and tenderness upon palpation of the lower abdomen indicate cold stagnation in the Bladder Guan Yuan area. (Moxibustion should be applied to Guan Yuan.) Fever, diarrhea, cold reversal, and restlessness preventing lying down indicate a fatal prognosis.

Patients with cold hands and feet and a suddenly tight pulse indicate pathogenic accumulation in the Stomach. Fullness and irritability in the epigastrium with inability to eat indicate the pathology is in the Chest; emesis is indicated. Gouti San [Seeds of Melon Trichosanthes Powder] is appropriate. This formula is suitable for all conditions requiring emesis.

Gouti (Thistle Fruit), Chixiaodou (Red Adzuki Bean) (equal parts).

Grind into fine powder. Separately, decoct Xiangchi (Prepared Soybean) one he with three cups of hot water until a thin porridge forms, strain. Mix one qian of the powder with the decoction and take warm in one dose. If vomiting does not occur, gradually increase the dose and retake until comfortable vomiting ensues. Contraindicated in patients with blood loss or deficiency. (Some use Dingxiang [Clove] for emesis, which often aggravates Huoxuan [Cholera-like] dryness.)

In Shaoyang disease with cold reversal and epigastric palpitations, treat the water retention first with Fuling Gancao Tang [Poria and Licorice Decoction], then treat the cold reversal. Otherwise, water infiltrating the Stomach will cause diarrhea.

Fuling (Poria), Guizhi (Cinnamon Twig) (each 1 liang), Shengjiang (Fresh Ginger, 1.5 liang), Gancao (Licorice Root, 0.5 liang).

Coarsely chop, decoct in two sheng of water to one sheng. Drink one wan warm until palpitations cease.

After severe purgation in Shaoyang disease on the sixth or seventh day, if the Cun pulse is deep and slow, hands and feet are cold, lower pulses are imperceptible, throat is obstructed, spitting of pus and blood occurs, and diarrhea is intractable, this is difficult to treat. Mahuang Shengma Tang [Ephedra and Corydalis Decoction] is appropriate. (Also applicable to spontaneous diarrhea with epistaxis not caused by purgation.)

Mahuang (Ephedra Herb, 1 liang), Shengma (Corydalis Rhizome), Danggui (Angelica Sinensis Root) (each 0.5 liang), Zhimu (Anemarrhena Rhizome), Huangqin (Scutellaria Root), Weirui (Polygonatum Rhizome) (each 3 qian), Shaoyao (Peony Root), Tianmendong (Asparagus Tuber), Guizhi (Cinnamon Twig), Fuling (Poria), Gancao (Licorice Root), Shigao (Gypsum Fibrosum), Baizhu (Atractylodes Macrocephala Rhizome), Ganjiang (Dried Ginger) (each 1.5 qian).

Coarsely chop, decoct in two and a half sheng of water. Boil Mahuang briefly, skim foam, add other herbs, boil to one and two-tenths sheng, strain. Drink one wan warm. After walking for the time it takes to cover seven or eight li, take another dose. Stop administration once sweating occurs.

For pre-existing cold patterns mistakenly treated with emesis and purgation, leading to increased cold rejection and immediate vomiting upon ingestion, Ganjiang Huangqin Tang [Dried Ginger and Scutellaria Decoction] is appropriate.

Ganjiang (Dried Ginger), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Renshen (Ginseng Root) (each 1.5 liang).

Coarsely chop, decoct in three sheng of water to one and a half sheng, strain. Drink one wan warm.

In diarrhea with mild fever and thirst, a weak pulse indicates self-healing. A rapid pulse with sweating indicates the same. A tight pulse indicates unresolved pathogen. Fever with cold reversal and diarrhea persisting for seven days is difficult to treat.

For general cold reversal, Sini Tang [Frigid Extremities Decoction] is universally used. See "Sini Patterns" for the formula. This applies when the pulse is floating and slow, or faint, or fine, or deep, indicating interior cold.

Cold reversal with a slippery pulse indicates interior heat; Baihu Tang [White Tiger Decoction] is the primary treatment.

Zhimu (Anemarrhena Rhizome), Shigao (Gypsum Fibrosum) (each 8 liang), Gancao (Licorice Root, 0.5 liang), Jingmi (Rice, 3 he).

Decoct in five sheng of water until rice is cooked and liquid remains, strain. Drink one wan warm, three times daily. Add Renshen (Ginseng Root) 0.5 liang if thirst is present.

Pang Anshi states: The Three Yang meridians all have He Bing (Combined Disease). There are fourteen types of He Bing, but the Three Yin meridians do not have He Bing.