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Taiyin and Jueyin diseases both use interior syndromes as their guiding principles. Taiyin belongs to Yin within Yin and governs cold, therefore there is no thirst; Jueyin belongs to Yang within Yin and governs heat, therefore there is Xiao Ke (polydipsia/excessive thirst). Taiyin governs damp earth; when the earth organ is diseased, Qi sinks downward, and damp pathogen enters the stomach, causing abdominal pain and spontaneous diarrhea; Jueyin governs Ministerial Fire (Xiang Huo); when the fire organ is diseased, Qi rebels upward, and fire pathogen enters the Heart, causing pain and burning sensation in the heart region. Taiyin presents with abdominal fullness and vomiting, inability to eat; Jueyin presents with hunger but no desire to eat, and vomiting roundworms upon eating. Both involve inability to eat, yet Taiyin has fullness while Jueyin has hunger. Both involve vomiting, yet Taiyin vomits food while Jueyin vomits roundworms. This distinguishes those belonging to Earth from those belonging to Wood. Taiyin governs "opening"; it naturally has diarrhea, and if purged incorrectly, the "opening" collapses, leading to epigastric stiffness and fullness, which is a reversal of "opening collapse"; Jueyin governs rebellious Qi, and if purged incorrectly, the Qi collapses, leading to unceasing diarrhea, which is a reversal where "collapse" leads to abnormal "opening".

When two Yins intersect and exhaust, it is named Jueyin, also called the extreme Yang of Yin; theoretically, Jueyin should have no heat. However, Jueyin governs the Liver, and the Gallbladder resides within the Liver; thus, Jueyin heat syndromes all originate from the internal activation of Shaoyang Ministerial Fire (Xiang Huo). It must be understood that Shaoyang and Jueyin share the same Ministerial Fire. When Ministerial Fire enters the interior, it is Jueyin disease; when it emerges to the exterior, it is Shaoyang disease. The dry throat of Shaoyang is the mechanism for Jueyin's polydipsia; chest and hypochondriac stuffiness is the precursor to Qi rushing up to strike the heart; irritability is the initial stage of evil heat; lack of desire to eat is the root of hunger without desire to eat; preference for vomiting is the gradual progression to vomiting roundworms. Therefore, if Shaoyang disease does not resolve, it transfers to Jueyin and becomes critical; if Jueyin disease declines, it transfers to Shaoyang and tends toward recovery. For example, in Shanghan (Cold Damage) with slight heat and mild cold extremities, cold fingertips, and lack of desire to eat, if after several days the heat subsides and the patient desires food, this indicates recovery.

The guiding principle of Taiyin is internal Cold Damage, not external contraction. The guiding principle of Jueyin is Warm Disease (Wen Bing), not Cold Damage. It must be known that each of the Six Channels has its principal syndrome, which is Zhang Zhongjing's intent in combining Cold Damage and miscellaneous diseases in his discussion. Cold Damage in various channels generally lacks thirst; if Taiyin disease lacks aversion to cold but has thirst, it is a Warm Disease. Only in Jueyin Cold Damage, due to Liver Wood stagnation unable to disperse, heat becomes severe internally, stealing Mother Qi (Kidney Water) to control Fire, causing thirst and desire to drink water. If there is no aversion to cold, it should be treated as a Warm Disease. It must be known that Wen is the pathogen of Wind-Wood, which is the primary disease of Jueyin; Xiao Ke (polydipsia) is the root of Warm Disease, and Jue-Li (cold extremities and diarrhea) is the variation of Warm Disease. As stated in *Neijing*, "All heat diseases belong to the category of Cold Damage," which precisely fits this category.

For Jueyin's polydipsia, allowing water intake soothes the condition, following the patient's desire, but it should be given in small amounts to calm the situation. Giving large amounts of water instead exacerbates the Yin pathogen; one must assess whether the patient can still drink, fearing water flooding into the stomach. Comparing "thirst and desire to drink" with "hunger but no desire to eat" allows one to fully understand the pathology of Jueyin.

Cold extremities and a faint pulse nearly imperceptible are external symptoms of Jueyin Cold Damage; Danggui Sini Tang (Angelica Decoction for Nourishing Blood and Unblocking Collaterals) is the formula for the exterior aspect of Jueyin Cold Damage. Despite such severe Yin-cold, Ginger and Aconite are not used because Ministerial Fire resides in the Liver channel; although the exterior is cold, the viscera are not cold. Thus, those who first experience cold extremities will subsequently develop fever; the colder the extremities, the hotter the Liver and Gallbladder interior, hence "the deeper the Jue, the deeper the heat." Therefore, at the onset of Shanghan, when pulse and symptoms present thus, one must not hastily diagnose it as Deficiency-Cold and recklessly administer Ginger and Aconite, lest it cause future harm.

Jue always involves fever; fever and Jue correspond, "the deeper the Jue, the deeper the heat; the shallower the Jue, the shallower the heat." These four conditions constitute the fixed pattern of Jueyin Cold Damage. Fever preceding 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 abundance or scarcity of the person's Yang Qi, similar to how Taiyin Cold Damage uses "already febrile" and "not yet febrile" as interchangeable terms.

The cold and heat Jue in *Neijing* result from internal injury, differing from the external pathogens discussed in this treatise. *Neijing*'s heat Jue occurs only in the soles of the feet, arising from Kidney Fire at Yongquan (KI-1). This treatise's heat Jue results from heat in the Liver, causing cold hands and feet, hence "the deeper the Jue, the deeper the heat." *Neijing*'s cold Jue has cold but no heat; this treatise's cold Jue features initial Jue followed by subsequent fever. Heat prevailing leads to life, cold prevailing leads to death; this distinguishes internal injury from external contraction. Jueyin follows the logic of lunar phases; when Yin reaches its extreme, Yang is born. Thus, in Jueyin Cold Damage, Yang is prioritized. More fever and less Jue indicates generating Yang, so the disease should recover; more Jue and less fever indicates dying Yin, so the disease progresses. If there is excess heat, it may manifest as pus and blood in stool or carbuncles/pus, differing from *Neijing*'s heat Jue.

Yin Qi originates from the inner side of the five toes, Yang Qi from the outer side. When Qi and Blood harmonize, Ying and Wei circulate, Yin and Yang interconnect like a circle without end. In Jueyin, Yang is absent; in Jueyin disease, Yin and Yang do not connect smoothly, causing cold extremities. If heat is slight and Jue is mild with only cold fingertips, recovery is anticipated; if hands and feet become warm, even with diarrhea, it will self-resolve due to self-harmonization and smooth connection of Yin and Yang. If the pulse is faint with irritability, moxa applied to Jueyin channels with no return of warmth indicates death, signifying the severance of Yin and Yang Qi.

This chapter states: "In cases of various Si Ni (four-finger coldness/Jue), purgatives are contraindicated." It also says: "If Jue requires purgation but sweating is used instead, oral ulcers and redness will occur." These two meanings differ and must be understood contextually. Generally, Si Ni cannot be purged when the pulse is faint and nearly imperceptible in Shanghan, indicating external cold pressing tightly with internal heat not yet arisen. Sweating is indicated for deficiency-cold syndromes, hence "even for the deficient." Cases requiring purgation feature a slippery pulse with Jue, indicating internal heat closure, hence "the deeper the Jue, the deeper the heat." Sweating only draws fire upward and cannot dispel internal heat, causing oral damage. "Purgation" here means purging heat, not solid excrement. For heaviness in defecation, Sini San (Four Counterflow Powder) is used; for intense thirst drinking several liters, Baihu Tang (White Tiger Decoction) is used. These are purgative formulas for Jueyin to eliminate formless pathogens. Using Chengqi Tang would lead to unceasing diarrhea.

Diagnosing Jueyin pulses prioritizes Yang, but treating Jueyin disease prioritizes Yin. Thus, Danggui Sini Tang retains Shao Yao (Peony), Baitouweng Tang heavily uses Huang Qin (Scutellaria) and Huang Lian (Coptis), Wumei Wan (Mume Pill) uses Jin (catty) of Huang Lian plus 6 liang of Huang Bo (Phellodendron), and Fumai Tang (Restore Pulse Decoction) uses Jin of Di Huang (Rehmannia) plus 8 liang of Mai Dong (Ophiopogon). Note that faint pulse and cold extremities, though indicating Yin excess, do not necessarily mean Yang deficiency; thus, dispersing external pathogens is possible, but securing the interior is not. For knotted/intermittent pulse and palpitations, which seem like Yang deficiency, it is actually Yin weakness; large-dose Yin tonification is suitable, 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. *Jing* states: "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 extremities and diarrhea indicate Wood overcoming Earth. Subsequent fever implies diarrhea will stop, as Fire generates Earth. If Liver Fire rises and presses on the Heart, sweating and Qi rushing up to the heart occur; since the Heart rejects evil, the pathogen ascends, causing sore throat and bi-syndrome. If fever, diarrhea, and unceasing sweating occur, it is fatal, indicating floating Yang escaping, having Yin but no Yang, equivalent to Shaoyin Yang exhaustion. If Liver Fire moves inward to the Spleen, Fire and Earth harmonize, resulting in no sweating and self-resolving diarrhea. If fever and diarrhea persist, Liver Fire disturbs the Blood Chamber, causing pus and blood in stool. If fever, diarrhea, and unceasing Jue occur, it is fatal, indicating Earth failure and Wood aggression, severing the root of all Yang. Jueyin Cold Damage has two confusing symptoms involving Spleen and Lung invasion, requiring careful differentiation. One is abdominal fullness and delirium with floating-tight pulse at Cun, indicating Liver invading Spleen, named Zong (Vertical), treat by puncturing Qimen (LR-14). Abdominal fullness and delirium resemble Stomach excess, but floating-tight pulse without tidal fever is not Yangming. *Mai Fa* states: "Floating and tight is named Xian (Wiry)." This is the Liver pulse. *Neijing* states: "All abdominal distensions belong to heat." And: "Excess Liver Qi causes excessive talking." Thus, fullness stems from Liver Fire, delirium from Liver Qi. Excess Wood insults what it conquers, directly attacking Spleen Earth, hence named Zong. Another is fever, shivering aversion to cold, extreme thirst, and abdominal fullness, indicating Liver invading Lung, named Heng (Horizontal), treat by puncturing Qimen. Fever and aversion to cold resemble Taiyang exterior; extreme thirst without heavy sweating is not Yangming transfer; abdominal fullness without mistaken purgation is not Taiyin transfer. No headache, no Stomach excess, no diarrhea rules out these three channels. Knowing fever/aversion to cold is Lung disease, Lung deficiency allows Liver Fire to invade. Splee fears Wood, Water Essence fails to ascend to Lung, causing thirst; Lung fails to regulate water passages, causing fullness. This insults the unconquered and shows fearlessness, hence named Heng. Whether Zong (invading Spleen) or Heng (invading Lung), it is always Liver hyperactive fire, requiring draining not tonifying, puncturing Qimen to drain excess. Once the Mu Yuan clears, Qi flows smoothly, resolving exterior and interior. This cannot be treated by sweating, vomiting, purging, or cooling methods, hence acupuncture is appropriate.

Shanghan with Yang pulse choppy, Yin pulse wiry, and acute abdominal pain also indicates Liver invading Spleen. First give Xiaojianzhong Tang (Minor Construct the Middle Decoction) to calm Spleen, then Xiaochaihu Tang (Minor Bupleurum Decoction) to soothe Wood. Note that Xiaojianzhong Tang is Guizhi Tang doubled Shao Yao to pacify Wood, plus Yitang (Maltose) to relieve urgency, a divine formula for Jueyin to expel evil, release exterior, harmonize middle, and stop pain. If unresolved, Middle Qi is weak and stagnant, pathogen lingers; follow with Xiaochaihu Tang to tonify middle and release exterior, directing Wood pathogen to Shaoyang for an exit, meaning "Yin emerging to Yang leads to recovery." Zhang Zhongjing uses two formulas for one syndrome: in Taiyang, Mahuang then Guizhi is exterior-then-interior method; in Jueyin, Xiaojianzhong then Chaihu is interior-then-exterior method, also facilitating Jueyin's transfer to Shaoyang.

Shanghan with Jue and palpitation below the heart also indicates Liver invading Lung. Though no fever/aversion to cold, it is Wood excess and Metal deficiency causing unfavorable Water Qi. The abdominal fullness case has water in Middle Jiao, treated by puncturing Qimen to drain excess. This case has water in Upper Jiao, treated by Fuling Gancao Tang (Poria and Licorice Decoction) to induce sweating. This formula transforms water into sweat, dispersing internal pathogens, serving as the Jueyin treatment for Jue.

The pulse of Jueyin Fengzhong (Wind Strike) differs from other channels. Usually floating pulse indicates Wind; here, non-floating indicates non-recovery, meaning Jueyin Wind Strike pulse is sinking. This originates from Yin deficiency, Wind entering the earth, Wood stagnation failing to舒展, hence non-recovery; slight floating indicates Wind moving on earth, vegetation renewing, restoring Jueyin Wind-Wood normalcy, hence recovery.

Generally, floating pulse indicates Exterior, sinking indicates Interior. Jueyin Wind Strike, with sinking pulse, has interior symptoms.

This heat diarrhea with heaviness is Jueyin Wind Strike. Taiyang Wind Strike with diarrhea and vomiting involves Water Qi; Jueyin Wind Strike with heat diarrhea and heaviness involves Fire Qi. Thus, Baitouweng Tang is main to treat Wind, Huang Qin and Huang Lian assist to clear Fire, plus Qin Pi to lift Wind from deep earth, allowing Liver Wood to flourish. Diarrhea with thirst is Jueyin's Xiao Ke, caused by Wind Strike irritability. Diarrhea with sinking-wiry pulse: sinking is interior, wiry is Wind. Wiry-large indicates Wind moved by Fire, so diarrhea persists. Weak-rapid indicates Wind-Fire power waning, so diarrhea stops. Fever without death indicates Yin emerging to Yang. Diarrhea with slight fever and sweating, showing Wind Strike symptoms, means interior symptoms emerge to exterior, Wind scatters externally, leading to self-recovery. Recovery pulse should be slightly floating. If Cun pulse is floating-rapid, Wind gone but Heat remains, Chi pulse choppy indicates Heat injuring Yin collaterals, Liver Blood failing to store, leading to pus/blood in stool.

Jueyin Wind Strike heat diarrhea indicates interior Heat; Shanghan also has Xie Re Li (collateral heat diarrhea) indicating interior Cold. This differs from Jue Li; Jue Li stops diarrhea when fever appears. Here, no diarrhea for 6-7 days, then fever and diarrhea with unceasing sweating, indicates exterior heat and interior cold, having Yin but no Yang. Note *Neijing*'s curled tongue and contracted testicles indicate Yang excess and Yin deficiency, so severe heat is treatable.

Jueyin diarrhea includes cases due to Jue, collateral heat, and internal heat, all belonging to Heat, namely Ministerial Fire carrying Wind-Wood as pathology.

Yin Yang Yi (Exchange of Yin and Yang) disease originates from Jueyin lust/fire. Initially, Liver Fire movement injures Shaoyin Essence; subsequently, Shaoyin Essence fails to store, and Jueyin Fire runs wild. Thus, lower abdominal tension, genital cramping, heat rushing to chest, visual spots, body heaviness, shortness of breath, heavy head unwilling to lift, are all disasters of Jueyin Ministerial Fire. Suddenly changing the sinews, vessels, form, and Qi of a healthy person. This is a symptom of plague contagion, bringing disaster to others.