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The arrival of heat is characterized by its emergence and subsequent disappearance. After three days, upon palpating the pulse, if the fever persists, recovery is expected at midnight of the following day. The reason for this prediction is that there was originally fever for six days, followed by cold limbs (Jue) for nine days, and then fever for another three days. Adding the previous six days to these three makes nine days in total, corresponding to the duration of the cold limbs; hence, recovery is anticipated at midnight of the next day. If, after three days, the pulse is rapid and the fever does not cease, this indicates an excess of heat qi, which will inevitably lead to the formation of carbuncles and suppuration.

The Shaoyin meridian houses the True Yang within and is most susceptible to cold limbs (Si Ni); therefore, it is stated that vomiting, diarrhea, with hands and feet not cold, but rather accompanied by fever, indicates a non-fatal prognosis. In the Jueyin meridian, there is no True Yang internally, so one does not worry about cold limbs per se, but rather about the inability to generate heat or having less heat and more cold limbs. However, Jue patterns often accompany diarrhea, where yang-heat transforms into yin-cold in six or seven out of ten cases. The treatise fears that sudden heat may emerge and then disappear. After three days, if palpation shows the heat remains, it describes the severe heat pulse and symptoms of Jue as if seen clearly. When heat and Jue correspond, there are particularly no subsequent complications. If heat qi is excessive, although the disease trend may recede, carbuncles and suppuration will inevitably develop later because Jueyin governs blood, and heat combined with lingering stagnation will inevitably cause obstruction and decay.

In Cold Damage presenting with cold limbs and palpitations in the epigastrium, water retention should be treated first using Fuling Gancao Tang (Poria and Licorice Decoction). If one treats the cold limbs without addressing the water, the water will infiltrate the stomach, inevitably causing diarrhea.

Cold Damage presenting with cold limbs and palpitations in the epigastrium is caused by deep-seated pathogenic heat and excessive drinking, leading to water qi assaulting the heart. Water is feared by Heart Fire; thus, when water assaults, it causes palpitations and restlessness. The harm caused by drinking water is greater than other pathogens. Therefore, before the water infiltrates the stomach, Fuling Gancao Tang is used first to clear the source of diarrhea, preventing the subsequent occurrence of cold limbs, so that cold limbs and diarrhea do not occur together.

After diarrhea, if irritability increases, and pressure on the epigastrium yields softness, this is deficiency irritability (Xu Fan), suitable for Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction).

Although diarrhea has occurred and irritability persists, suggesting incomplete resolution of pathogens, if the epigastrium is soft and not full, it is deficiency irritability. This is quite similar to the pattern of stomach deficiency and diaphragm heat following erroneous purgation in Yangming disease; thus, both are treated with emetic methods.

In Cold Damage lasting six or seven days, after severe purgation, if the cun pulse is deep and slow, hands and feet are cold, the lower pulses are imperceptible, the throat is obstructed, sputum contains pus and blood, and diarrhea/dysentery is unceasing, this is difficult to treat and is managed with Mahuang Shengma Tang (Ephedra and Corydalis Decoction).

This represents complex pathogens involving both exterior and interior. Although difficult to treat, it is not fatal. The deep and slow cun pulse after purgation clearly indicates yang pathogens sinking into yin, not comparable to simple yang qi decline. Cold limbs indicate the failure of Stomach Qi to distribute. The absence of lower pulses is due to the depletion of yin fluids from unceasing diarrhea. Throat obstruction and expectoration of pus and blood result from yang pathogens clashing with yin and reversing upward. Thus, Zhang Zhongjing specifically extracts yang from yin conditions, allowing sweat to emerge so that complex pathogens are fully resolved. ○ A question arises: Why is there an example of Mahuang Shengma Tang in Jueyin disease, given that Taiyang, Yangming, and Shaoyang diseases typically use sweating methods? Detailed examination reveals this condition originated as Winter Warmth. Due to sore throat and diarrhea, it was mistakenly diagnosed as Cold Damage and treated with purgation, leading to unceasing diarrhea, deep/slow pulses, and cold limbs—all signs of heat pathogens sinking inward. Fortunately, true yin was not exhausted, allowing the body to drive pathogens outward, manifesting as throat obstruction and expectoration of pus and blood. This indicates heat pathogens returning and wandering along the Shaoyin meridian, also signifying liver wood drying and spleen earth burning, damaging lung metal. The formula uses Mahuang and Shengma to raise sunken heat; Guizhi, Baishao, Gancao, and Danggui harmonize Ying and Wei. Since Taiyang and Shaoyin pathogens have merged into Jueyin, Danggui is added to Guizhi Tang to nourish yin blood. Wujia (Polygonatum odoratum/Tian Dong context implies nourishing yin/fluids, here likely referring to Yu Zhu/Wujia Pi in some contexts, but text says Wujia Tian Dong, likely Yu Zhu and Asparagus Root) connects downward to Kidney Qi to nourish the upper source. Wujia is a specific herb for wind-warmth sore throat and hot cough. Although the text does not mention cough, throat obstruction and pus/blood imply severe coughing precedes pus discharge. Huangqin, Baishao, and Gancao treat internal diarrhea caused by pathogens merging inward; Zhimu, Shigao, and Gancao treat cold limbs due to heat latent in Shaoyin. Since pathogens lie latent in Shaoyin, Zhimu is needed to remove stagnant heat; since heat must resolve via Yangming, Shigao is needed to open the pores. Ganjiang, Baizhu, and Fuling are used because severe purgation has damaged the middle jiao, requiring protection of the spleen and stomach. Zhu Fengyi modified this decoction by removing Shengma, Zhimu, Tian Dong, Baishao, and adding Gegen, Qianghuo, Chuanxiong, Xingren, Baiwei, Qingmuxiang to treat wind-warmth, staying within this therapeutic scope.

In Cold Damage, if cold limbs appear first, followed by fever and diarrhea, the diarrhea will stop spontaneously. If cold limbs reappear, diarrhea will return.

"First cold limbs, then fever, with diarrhea" refers to the exterior syndrome of Cold Damage resolving, initially presenting with cold limbs and diarrhea, followed by fever. It does not mean Yin syndromes present with cold limbs and diarrhea from the onset. "First cold limbs, then fever, with diarrhea stopping spontaneously" is the normal course of Jueyin disease. "Reappearance of cold limbs leads to diarrhea" is a precaution against potential changes. If cold limbs and diarrhea cease but fever persists, and sore throat or laryngeal obstruction appears, or bloody/purulent stools occur, it becomes a pattern of excess yang-heat. These are complex yin-yang patterns.

In Cold Damage, if cold limbs precede fever, diarrhea stops spontaneously, but sweating and sore throat occur, laryngeal obstruction (Bi) develops. If fever occurs without sweating, diarrhea stops spontaneously; if it does not stop, bloody/purulent stools will occur. In cases of bloody/purulent stools, laryngeal obstruction does not occur.

If cold limbs precede heat and diarrhea stops, the disease is about to heal. However, if sweating and sore throat occur, it is pathogenic heat carrying phlegm-dampness attacking upward, causing laryngeal obstruction. Since there is fever and no sweating, pathogens are exiting outward, so diarrhea stops. If diarrhea does not stop, the lack of sweating indicates pathogens are not exiting but remaining inside, inevitably leading to bloody/purulent stools. In cases of bloody/purulent stools, laryngeal obstruction does not occur, showing that heat pathogens in the interior are no longer in the exterior, and those below are no longer above. Laryngeal obstruction is treated with Jiegeng Tang; bloody/purulent stools are treated with Baitouweng Tang.

In Cold Damage, from one or two days to four or five days, if cold limbs appear, fever will follow. If fever preceded, cold limbs will follow. Deep cold limbs indicate deep heat; mild cold limbs indicate mild heat. Cold limbs should be treated with purgation. If sweating is used instead, oral lesions and redness will occur.

At the onset of Cold Damage (one or two days), symptoms are all yang patterns of aversion to cold and heat. By four or five days, transmission to yin meridians begins, resulting in cold limbs. Previously, it was stated that various Si Ni (cold limbs) patterns should not be purged. Here, it states purgation should be used. The distinction is subtle. Prior Si Ni differs from patterns where fever precedes cold limbs. Hence, the former advises against purgation, while this one recommends it because deep heat causes deep cold limbs. Bitter-cold herbs should be used to clear interior heat, offering a chance of survival; Xiaoxianxiong Tang combined with Xiao Chengqi Tang is appropriate. Even with diarrhea and delirium, only Xiao Chengqi Tang is used. Severe purgation is never heard of. Using acrid-sweet sweating agents instead of bitter-cold would surely aggravate heat ascending. Oral lesions/redness corresponds to laryngeal obstruction.

For patients vomiting pus due to carbuncles, vomiting should not be treated directly; once the pus is expelled, self-healing occurs.

Vomiting can result from stomach deficiency-cold or liver qi rebellion, both treated with acrid-warm herbs to direct rebellious qi downward. However, this case involves heat gathering in the stomach, forming carbuncles and pus, causing vomiting. This aligns with the *Neijing* description of heat gathering at the stomach opening, leading to gastric carbuncles. To prevent misuse of acrid-warm anti-emetics, it is emphasized not to treat the vomiting directly. One should wait for the pus to clear naturally, meaning since the heat has an outlet, medication should not be used to damage stomach qi.

In Cold Damage with diarrhea occurring over ten times a day, if the pulse is unexpectedly solid/excess, the prognosis is fatal.

During the peak of yang-ming heat, the pulse should be solid. Now, in the Jueyin stage, pathogens are waning, and with frequent diarrhea, a solid pulse indicates righteous qi decline and pathogen excess, hence fatal.

For hot dysentery with a sensation of heaviness in the rectum, Baitouweng Tang (Pulsatilla Decoction) is indicated.

Hot dysentery with rectal heaviness indicates a mixture of damp-heat.

For diarrhea accompanied by thirst, it is due to internal heat, treated with Baitouweng Tang.

Diarrhea with thirst differs from cold-viscera diarrhea without thirst; it results from heat consuming fluids internally. Even without rectal heaviness, the aforementioned formula should be used to overcome the heat. These are pure yang patterns without yin involvement.

For vomiting accompanied by fever, Xiao Chaihu Tang (Minor Bupleurum Decoction) is indicated.

When Jueyin pathogens disperse, they reverse upward to Shaoyang, causing fever and vomiting. Since the Liver and Gallbladder are interior-exteriorly related, Xiao Chaihu Tang is used to lift Jueyin pathogens and dissipate them via Shaoyang. This section describes Jueyin transforming into Shaoyang meridian patterns.

After diarrhea, if body pain persists but bowel and bladder functions are normal, the exterior should be urgently addressed using Guizhi Tang (Cinnamon Twig Decoction) to induce sweating.

After Jueyin diarrhea ceases and bowel/bladder functions normalize, interior cold has retreated. Body pain indicates pathogens have returned to the exterior. Guizhi Tang is used to harmonize Ying and Wei for recovery. This section describes Jueyin returning to yang and heat resolving from the exterior.

Jueyin disease tends to resolve between Chou hour (1-3 AM) and Mao hour (5-7 AM). This section describes the natural resolution timing of Jueyin meridian patterns.