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Taiyin and Jueyin diseases both take interior syndromes as their guiding principles. Taiyin is the extreme yin within yin and governs cold; therefore, there is no thirst. Jueyin is yang within yin and governs heat; therefore, xiaoke (polydipsia) occurs. Taiyin governs damp earth. When earth is diseased, qi sinks downward, and damp pathogen enters the stomach, causing abdominal pain and spontaneous diarrhea. Jueyin governs ministerial fire. When fire is diseased, qi rebels upward, and fire pathogen enters the heart, causing pain and heat in the heart. Taiyin presents with abdominal fullness and vomiting, with food unable to go down. Jueyin presents with hunger but no desire to eat, and vomiting roundworms upon eating. Both involve food failing to go down: Taiyin involves fullness, while Jueyin involves hunger. Both involve vomiting: Taiyin involves vomiting food, while Jueyin involves vomiting roundworms. This further distinguishes between those belonging to Earth and those belonging to Wood.

Taiyin belongs to "opening." It naturally has diarrhea; if purged, the opening collapses, leading to chest hardness, which is a reversal of opening into closing. Jueyin belongs to "closing." Qi rebels upward; if purged, the closing disintegrates, leading to unceasing diarrhea, which is a reversal of closing into opening. The convergence of two yins is named Jueyin, also known as the absolute yin of yang. Thus, Jueyin should theoretically have no heat. However, Jueyin governs the Liver, and the Gallbladder resides internally; therefore, all Jueyin heat syndromes originate from the internal activation of Shaoyang ministerial fire. One must understand that Shaoyang and Jueyin share the same ministerial fire. When ministerial fire is constrained internally, it is a Jueyin disease; when ministerial fire emerges externally, it is a Shaoyang disease. Shaoyang dry throat is the mechanism behind Jueyin polydipsia; chest and hypochondriac distress is the precursor to qi rushing up to strike the heart; mental irritability is the initial stage of heart pain and heat; lack of desire to eat is the root of hunger without desire to eat; preference for vomiting is the gradual progression toward vomiting roundworms. Therefore, if Shaoyang disease does not resolve and transfers to Jueyin, the condition becomes critical. If Jueyin disease wanes and transfers to Shaoyang, recovery is desired. For example, in Shanghan (Cold Damage), when heat is slight and cold limbs are minimal, with only the fingertips cold and no desire to eat, once the heat subsides and appetite returns, the disease heals. This is an illustration.

The guiding principle of Taiyin refers to internal cold damage, not external contraction. The guiding principle of Jueyin refers to warm disease, not cold damage. One must know that each of the six meridians has its own principal syndrome; this is Zhang Zhongjing's intent in combining Shanghan and miscellaneous diseases in his discussion. Cold damage in the various meridians typically lacks thirst. If Taiyin disease presents without aversion to cold but with thirst, it is a warm disease or a miscellaneous disease. Only in Jueyin cold damage does liver wood become constrained and unable to emerge, causing severe internal heat that seeks to borrow maternal qi (Kidney water) to control fire, resulting in thirst and desire to drink. If there is no aversion to cold, it should be treated as a warm disease. One must understand that warm disease is caused by wind-wood pathogen, which is the primary disease of Jueyin. Polydipsia is the root of warm disease, while jue-li (cold limbs with diarrhea) is a variation of warm disease. What the Neijing calls heat diseases all belong to the category of cold damage; this is precisely such a case.

For Jueyin polydipsia, water is given to accommodate the patient's desire. However, it should be given in small amounts to calm hyperactive fire; giving too much will instead augment yin pathogen. One must assess whether drinking alleviates the thirst, fearing water flooding into the stomach.

Thirst with desire to drink should be viewed in contrast to hunger without desire to eat to fully grasp the pathology of Jueyin disease.

Cold limbs and pulse faint to the point of disappearance are exterior symptoms of Jueyin cold damage. Danggui Sini Decoction is the exterior formula for Jueyin cold damage. Despite such severe yin-cold, Ginger and Aconite are not used because ministerial fire resides in the Liver position. Although the exterior is cold, the zang organs are not cold. Therefore, those who first experience jue will later develop fever. The colder the hands and feet, the hotter the Liver and Gallbladder. Hence, "the deeper the jue, the deeper the heat." Thus, at the onset of Shanghan, when pulse and symptoms present thus, one must not hastily diagnose deficiency-cold and recklessly administer Ginger and Aconite, thereby causing future harm. Jue must be accompanied by fever; fever and jue correspond. Deep heat leads to deep jue; slight heat leads to slight jue. These four presentations constitute the fixed pattern of Jueyin cold damage. Fever followed by jue, alternating jue and fever, more jue than fever, and more fever than jue constitute the variable patterns of Jueyin cold damage. All depend on the quantity of the person's yang qi. For instance, in Taiyin cold damage, there is also the reciprocal usage of "already febrile" and "not yet febrile."

The cold and hot jue in the Neijing result from internal injury, differing from the external pathogens discussed in this treatise. In the Neijing, hot jue is confined to the sole of the foot, arising from Kidney water below the Yongquan acupoint. In this treatise, hot jue results from heat in the Liver, causing cold hands and feet; hence, "the deeper the jue, the deeper the heat." In the Neijing, cold jue involves cold without heat. In this treatise, cold jue begins with cold limbs but is inevitably followed by fever; heat prevailing leads to life, cold prevailing leads to death. This distinguishes internal injury from external contraction.

Jueyin possesses the principle of the conjunction of new and full moons (extreme yin generating yang). Therefore, Jueyin cold damage prioritizes yang. Less jue and more heat indicates generating yang, so the disease should heal. More jue and less heat indicates dying yin, so the disease progresses. If heat qi is excessive, pus and blood may appear in stool, or carbuncles and pus may develop. This differs from the hot jue in the Neijing.

Yin qi originates from the interior of the five toes; yang qi originates from the exterior. When qi and blood harmonize, and Ying and Wei circulate, yin and yang interconnect like a circle without end. Jueyin lacks yang; in Jueyin disease, yin and yang do not connect smoothly, causing reverse cold in the hands and feet. If heat is slight and jue is minimal, with only fingertip cold, the disease can heal. If hands and feet become warm, even with diarrhea, it will self-resolve due to the self-harmonization and smooth connection of yin and yang. Conversely, if pulse is faint with irritability, and after moxibustion of Jueyin points, jue does not reverse, death ensues, indicating the exhaustion of yin and yang qi.

This treatise states: "All cases of Sini jue should not be purged," and also says: "Jue should be purged." Yet, if sweating is induced instead, mouth sores and redness will occur. These two statements differ in meaning and must be understood in context. "All Sini" refers to deficiency-cold syndromes, hence "deficient persons are also like this." "Should be purged" refers specifically to hot jue, hence "the deeper the jue, the deeper the heat." Sweating only draws fire upward and cannot expel heat outward, causing mouth injury. If hands and feet are cold with pulse faint to disappearance, when external cold is pressing and internal heat has not yet arisen, sweating is appropriate.

Jue with pulse faint to disappearance is the pulse of onset in Shanghan, corresponding to "should not be purged." Slippery pulse with jue indicates internal heat constraint, corresponding to "jue should be purged." Purging here targets heat, not excess solid matter. For heaviness in defecation, Six Reversal Powder (Sini San) is used. For intense thirst requiring several liters of water, White Tiger Decoction (Baihu Tang) is used. These are the purgative formulas for Jueyin, targeting formless pathogens. Using Chengqi Decoctions would lead to unceasing diarrhea. Diagnosing Jueyin disease prioritizes yang, but treating it prioritizes yin. Thus, Danggui Sini Decoction retains Peony; Baitouweng Decoction heavily uses Coptis and Phellodendron; Wumei Pill uses one jin of Coptis and adds six liang of Phellodendron; Fumai Decoction uses one jin of Rehmannia and adds eight liang of Ophiopogon. One must know that although faint pulse and cold limbs indicate yin excess, they do not necessarily imply yang deficiency. Exterior pathogens can be dispersed without consolidating the interior. Intermittent pulse and palpitations suggest yang deficiency but actually indicate yin weakness; massive yin-nourishing is required, not warming tonification. This is because the Liver's ministerial fire is the vital qi of Shaoyang, which originates from the true yin of Kan Palace. The Classics state: "Yang provides correctness, Yin serves as master." Also: "Yin deficiency leads to lack of qi." And: "Lesser fire generates qi, greater fire consumes qi." Understanding this reveals the principle of treating Jueyin.

The central region and limbs are governed by the Spleen. In Jueyin cold damage, cold limbs with diarrhea indicate Wood overcoming Earth. If fever returns, diarrhea stops, indicating Fire generating Earth. If Liver fire rises and presses the Heart, sweating occurs, qi rushes up to strike the heart, and since the Heart rejects evil, the pathogen ascends, causing sore throat and pharyngeal bi. If fever, diarrhea, and unceasing sweating occur, death results from yang collapse and external loss, having yin but no yang, equivalent to Shaoyin yang collapse. If Liver fire moves inward to the Spleen, Earth and Fire combine, sweat ceases, and diarrhea stops. If fever and persistent diarrhea occur, Liver fire has sunk inward, disturbing the Blood Chamber, leading to pus and blood in stool. If fever, severe diarrhea, and unceasing jue occur, death results from Earth failure and Wood aggression, severing the root of all yang. Jueyin cold damage has two suspected syndromes: attacking the Spleen and attacking the Lung, which require careful differentiation.

One type is Shanghan with abdominal fullness and delirious speech, floating and tight radial pulse. This is Liver attacking Spleen, named "Zong" (Vertical), treated by puncturing Qimen. Abdominal fullness and delirium resemble Stomach excess, but floating-tight pulse without tidal fever is not Yangming. Pulse theory states: floating and tight is called Xian (Wiry), which is the Liver pulse. The Neijing states: all abdominal distension belongs to heat. Also: Liver qi excess causes talkativeness. Thus, fullness stems from Liver fire, and delirium from Liver qi. Wood excess insults what it overcomes, directly invading Spleen Earth, hence named Zong.

Another type is Shanghan with fever, shivering aversion to cold, intense thirst, and abdominal fullness. This is Liver attacking Lung, named "Heng" (Horizontal), treated by puncturing Qimen. Fever and aversion to cold resemble Taiyang exterior, but intense thirst without heavy sweating is not transferring to Yangming. Abdominal fullness without mistaken purgation is not transferring to Taiyin. No headache, no Stomach excess, no diarrhea rules out Three Yin diseases. Fever and aversion to cold are Lung diseases. Lung deficiency allows Liver fire to invade. Spleen fears Wood, preventing fluid essence from ascending to the Lung, causing intense thirst. Lung fails to regulate water passages, causing abdominal fullness. This insults what it cannot overcome, lacking fear, hence named Heng. One vertical attacking Spleen, one horizontal attacking Lung; both stem from hyperactive Liver fire, requiring draining, not tonifying. Puncturing Qimen drains excess. Clearing the Mu-Yuan allows the three qi to flow smoothly, resolving exterior and interior. This cannot be treated by sweating, vomiting, purging, clearing, or draining methods; acupuncture is indicated.

Shanghan with choppy superficial pulse and wiry deep pulse, with acute abdominal pain, is also Liver attacking Spleen. First, give Xiao Jianzhong Decoction to stabilize Spleen, then Xiaochaihu Decoction to soothe Wood. Xiao Jianzhong Decoction is Guizhi Decoction plus Peony to calm Liver and Malt Sugar to relieve urgency. It is a divine formula for dispelling evil, releasing exterior, harmonizing middle, and relieving pain in Jueyin cold damage. If ineffective, middle qi is deficient and stagnant, with lingering pathogen. Follow with Xiaochaihu Decoction to tonify middle and release exterior, directing Wood pathogen to Shaoyang for an exit, allowing yin to emerge into yang for healing. Zhang Zhongjing uses two formulas for one syndrome: in Taiyang, Mahuang Decoction followed by Guizhi Decoction is exterior-then-interior; in Jueyin, Xiao Jianzhong followed by Xiaochaihu is interior-then-exterior, facilitating transfer from Jueyin to Shaoyang.

Shanghan with jue and epigastric palpitation is also Liver attacking Lung. Even without fever and aversion to cold, it results from Wood excess and Metal deficiency, causing unfavorable Water qi. The abdominal fullness case involves Water qi in the Middle Jiao, treated by puncturing Qimen to drain excess. Here, Water qi is in the Upper Jiao, treated by Fuling Ganjiang Decoction to induce sweating. This formula transforms water into sweat, dispersing internal evil, serving as a treatment for Jueyin jue.

The pulse of Jueyin Wind Strike differs from other meridians. Floating pulse indicates wind; here, non-floating indicates non-recovery. Jueyin Wind Strike features a sinking pulse because Wood remains in yin positions, wind enters the earth, and Wood qi is constrained, hence not recovered. Slight floating indicates wind moving on the ground, vegetation renewing, restoring normal Jueyin wind-wood, hence recovery.

Floating pulse indicates exterior; sinking indicates interior. Jueyin Wind Strike has sinking pulse and interior symptoms. "Hot diarrhea with tenesmus" is Jueyin Wind Strike. Taiyang Wind Strike with diarrhea and vomiting involves Water qi; Jueyin Wind Strike with hot diarrhea and tenesmus involves Fire qi. Thus, Baitouweng Decoction treats wind, Huangqin and Huanglian clear fire, and Qinpi lifts wind from the depths, allowing Liver Wood to flourish. Diarrhea with thirst is Jueyin polydipsia, caused by wind-strike irritability. Diarrhea with sinking-wiry pulse: sinking is interior, wiry is wind. Wiry and large indicates wind stirred by fire, so diarrhea persists. Weak-rapid pulse indicates less wind and slight fire, so it self-resolves. Fever without death indicates yin emerging into yang. Diarrhea with slight fever and sweating is the original wind-strike symptom; interior symptoms emerging to exterior allows wind to scatter outward, leading to self-healing. The pulse for recovery should be slightly floating. If cun pulse is floating-rapid, wind leaves but heat remains; chi pulse is choppy, indicating heat in yin collaterals and uncontained Liver blood, leading to pus and blood in stool.

The hot diarrhea of Jueyin Wind Strike indicates interior heat. Shanghan also has hot diarrhea, but with interior cold. This differs from jue-li. In jue-li, fever stops diarrhea. Here, after six or seven days without diarrhea, fever and diarrhea begin with unceasing sweating, indicating exterior heat and interior cold, termed "having yin but no yang." Note that Neijing's tongue curling and scrotal retraction indicate "having yang but no yin," so despite high heat, it is treatable.

Yin-Yang Exchange disease originates from Jueyin lust. Initially, Liver fire movement injures Shaoyin essence. Subsequently, Shaoyin essence fails to store, and Jueyin fire runs wild. Thus, Shaoyin interior deficiency causes genital cramping, heat rushing to the chest, visual spots, and heavy head unwilling to lift. All are disasters of Jueyin ministerial fire, suddenly altering the sinews, vessels, form, and qi of previously healthy individuals. This is a symptom of warm epidemic transmission, bringing disaster to others.