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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When Yang Qi (vital energy associated with warmth and activity) is deficient in the lower part of the body, Cold Jue (a condition characterized by cold extremities due to Yang deficiency) occurs; when Yin Qi (vital energy associated with cooling and substance) is deficient in the lower part, Heat Jue (a condition characterized by hot extremities due to Yin deficiency) occurs. It further states: Regarding Cold Jue, this type of person has a robust constitution but squanders their essence during autumn and winter (e.g., through excessive sexual activity). The Qi below contends upward but cannot recover; essence overflows from below, and pathogenic factors follow it upward. Qi becomes stagnant in the middle jiao. Due to Yang deficiency, it fails to permeate and nourish the meridians. Yang Qi diminishes daily, leaving only Yin Qi present, hence the hands and feet become cold. Regarding Heat Jue, such a person must have engaged in sexual intercourse after being drunk and full. This leads to emptiness of essence within. Wine enters the stomach, filling the collaterals while emptying the main meridians. The Spleen is responsible for transporting and transforming fluids for the Stomach. When Yin Qi is deficient, Yang Qi enters inwardly. Once Yang Qi enters inwardly, the Stomach becomes disharmonious. When the Stomach is disharmonious, essence is exhausted. When essence is exhausted, it cannot permeate and nourish the four limbs. Qi gathers in the Spleen and cannot disperse. The qi of wine and the qi of grain contend with each other, causing intense heat in the center. Thus, heat pervades the whole body, internal heat arises, and urine becomes red. Kidney Qi declines daily, while Yang Qi becomes excessively strong, hence the hands and feet become hot. Furthermore, if Yin Qi is excessive in the upper part, the lower part becomes deficient. Lower deficiency leads to abdominal distension. Abdominal distension causes Qi in the lower part to become heavy and reverse upward, leading to Jue where pathogenic factors cause reversal. In Jue, Yang Qi becomes chaotic. Chaotic Yang Qi causes sudden collapse and loss of consciousness. Some may regain consciousness after half a day or even up to a day; this is named Shi Jue (Corpse Jue, a type of syncope caused by chaotic Qi mechanism). Examining Zhang Zhongjing’s *Shanghan Lun* (Treatise on Cold Damage), the syndromes of Yin and Yang Jue both refer to coldness reversing from the extremities inward. Liu Hejian, in his *Yuanbing Shi* (Original Causes of Diseases), states: For Yin Jue, the etiology, pulse, and symptoms all belong to Yin syndromes: the body is cool, there is no thirst, and the pulse is slow and thready. For Yang Jue, the etiology, pulse, and symptoms all belong to Yang syndromes: there is irritability, thirst, delirium, restlessness, the body is hot, and the pulse is rapid. If Yang Jue is extremely deep, or if failure to use purgatives leads to a cold body, presenting falsely as a Yin syndrome with a faint pulse nearing extinction and death, this is caused by extreme heat. Quack physicians mistakenly believe it has transformed into a Yin syndrome and urgently administer hot medicines to assist Yang Qi, resulting in no survivors out of ten. I observe: The Cold and Heat Jue described in the *Neijing* are common deficiency and exhaustion syndromes. Both are suitable for tonification methods, but Heat Jue requires tonifying Yin, while Cold Jue requires tonifying Yang. This aligns with the classic saying: "Strengthen the master of Water to suppress the flaring Sun" (nourish Kidney Yin to restrain hyperactive Yang heat), and "Benefit the source of Fire to dissipate the shade" (warm Kidney Yang to dispel Yin-cold pathogens). However, the Yin and Yang Jue described in the *Shanghan Lun* are as different as ice and charcoal, and their treatment methods differ. Between diagnosis and observation, life and death can reverse in the turning of a palm. How can physicians not exert themselves fully?

Pulse Diagnosis

The *Maijing* (Pulse Classic) states: At the Cun Kou (radial artery) position, if the pulse is deep, large, and slippery, "deep" indicates excess, and "slippery" indicates Qi stagnation. When excess and Qi stagnation clash, if Blood and Qi enter the Zang organs, death ensues; if they enter the Fu organs, recovery occurs. This is called Cu Jue (Sudden Jue). Loss of consciousness, blue lips, and cold body indicate entry into the Zang organs leading to death; if the body is warm and sweat comes spontaneously, it indicates entry into the Fu organs followed by self-recovery.

The *Huren Shu* (Book Saving Lives) states: The pulse of Yang Jue is slippery and deep-excess; the pulse of Yin Jue is fine and deep-hidden.

Methods

Zhu Danxi states: Jue is mostly caused by Qi deficiency or Blood deficiency. Qi deficiency presents with a fine pulse; Blood deficiency presents with a large pulse like an onion stalk; Heat Jue presents with a rapid pulse; Exogenous Jue presents with a floating and excess pulse; Phlegm-related cases present with a wiry pulse. For Heat, use Chengqi Tang (Gut-Purging Decoction); for Phlegm, use Baizhu (Atractylodis Rhizoma) and Zhuli (Bamboo Sap); for exogenous factors, add Jiangzhi (Ginger Juice) to dispersing formulas.

(Above is one rule of Zhu Danxi’s methods regarding Jue.)

The *Huren Shu* states: Initially contracting the disease with fever, headache, constipation, dark urine, aversion to heat, desire for water, waving hands and throwing legs about, irritability preventing peaceful lying down, delirium, confusion, and Jue—this is Yang Jue, treated with Da Chaihu Tang (Major Bupleurum Decoction) or Xiao/Chengqi Tangs (Minor/Major Gut-Purging Decoctions). If thirsty, Baihu Tang (White Tiger Decoction) is excellent. Cold hands and feet with a knotted pulse (intermittent pulse) indicates pathogenic factors knotting in the chest, oppression and fullness below the heart, hunger but inability to eat; treat with Gouti San (Melon Seed Powder) to induce vomiting. Alternating chills and fever with Jue, lusterless complexion, dizziness, sudden absence of pulse in both hands or one hand—this indicates normal sweating will occur. Wrap hands and feet in cotton cloth, urgently administer Wuweizi Tang (Schisandra Decoction), or alternatively Guizhi Mahuang Ge Ban Tang (Half-Dose Combination of Cinnamon Twig and Ephedra Decoction). After a short while, profuse sweating will resolve the condition. For Shanghan-induced Jue with palpitations below the heart, first treat the water retention using Fuling Gancao Tang (Poria and Licorice Decoction). If after contracting the disease, there is coldness reversing in the four limbs, deep and fine pulse, leg cramping while lying down, aversion to cold, pulling clothes to cover oneself, no desire for water, or diarrhea with undigested food and Jue—this is Yin Jue, treated with Sini Tang (Recover the Extremities Decoction) or Baitong Tang (White Through Decoction). For Jue with absent pulse, use Tongmai Sini Tang (Unblocking the Mai Sini Decoction). For slight coldness in the fingertips, termed Qing Jue (Clear/Cold Jue), use Lizhong Tang (Regulate the Middle Decoction). For Jue without heat signs, use Danggui Sini Jia Zhuyu Shengjiang Tang (Angelica Sinensis Decoction to Nourish the Extremities plus Cornus and Ginger). For panting, hidden pulse, and Jue, use Wuweizi Tang. For vomiting and diarrhea, cold hands and feet, and irritability wishing to die, use Wuzhuyu Tang (Evodia Decoction).

Wuweizi Tang (from *Huren Shu*) treats Yang Jue with hidden pulse and cold hands and feet.
Wuweizi (Schisandra Fructus, 1 liang), Renshen (Ginseng Radix), Maidong (Ophiopogonis Tuber), Xingren (Prunus Semen), Chenpi (Citri Reticulatae Pericarpium) (each 5 qian).
Finely chop, add 3 zhan of water, 10 slices of Shengjiang (Fresh Ginger), and 2 dates. Decoct to 1.5 zhan, remove dregs, and divide into two doses.

Guizhi Mahuang Ge Ban Tang (See Shanghan section for formula.)

Fuling Gancao Tang treats Yang Jue with palpitations, cold hands and feet, and fluid retention below the heart.
Fuling (Poria), Guizhi (Cinnamomi Ramulus) (each 2 qian), Gancao (Licorice Radix, 1 qian), Shengjiang (Fresh Ginger, 3 qian).
Finely chop, prepare as one dose, add 1.5 zhan of water, decoct to 1 zhan, remove dregs, and take warm.

Tongmai Sini Tang (from *Huren Shu*) treats Yin Jue, diarrhea with undigested food, cold hands and feet, and faint pulse.
Gancao (Licorice Radix, 6.5 qian), Fuzi (Aconiti Lateralis Radix Preparata, 1 piece, raw), Ganjiang (Zingiberis Rhizoma, 1 liang, processed).
If the face is red, add 9 stems of Congbai (Allii Cepae Bulbus). If vomiting, add Shengjiang. If sore throat, add Jiegeng (Platycodon Radix). If diarrhea stops but pulse does not return, add Renshen.
Add 3 large zhan of water, decoct to 1.5 zhan, remove dregs, and divide into two doses.

Danggui Sini Jia Zhuyu Shengjiang Tang (from *Huren Shu*) treats Jue without heat signs.
Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix Alba), Guizhi (Cinnamomi Ramulus), Xixin (Asari Radix et Rhizoma) (each 1 liang), Gancao (Licorice Radix), Tongcao (Tetrapanacis Medulla) (each 6.5 qian), Wuzhuyu (Evodiae Fructus, 3 qian), Shengjiang (Fresh Ginger, 6 qian).
Finely chop, add 3 sheng of water, boil to 1.5 sheng, divide into three doses.

Wuzhuyu Tang (from *Huren Shu*) treats Yin Jue with vomiting and diarrhea, cold hands and feet, and irritability wishing to die.
Wuzhuyu (Evodiae Fructus), Shengjiang (Fresh Ginger) (each 5 qian), Renshen (Ginseng Radix, 3.5 qian).
Finely chop, prepare as one dose, add 2 zhan of water and 1 date. Decoct to 1.5 zhan, take warm. Avoid raw and cold foods.

Suhexiang Wan (Styrax Pill, from *Jufang*) treats sudden Jue with loss of consciousness. If the cause (Wind, Phlegm, or Qi) is unclear, this medicine is excellent initially. Use one pill each time, dissolve in warm water, and administer to induce awakening. After awakening, examine the pulse and use other medicines accordingly.

(Danxi’s Flexible Methods) states: Heat Jue with vexing heat in the four limbs is due to damp-heat stagnating in the Spleen Earth. Treat with Li Dongyuan’s Shengyang Sanhuo Tang (Raising Yang and Dispersing Fire Decoction) or Huoyu Tang (Depressed Fire Decoction). Cold Jue with cold hands and feet is mostly due to insufficiency of Qi and Blood; add Fuzi to Qi and Blood tonifying formulas. For drinkers or obese individuals with hot hands and feet, it is due to abundant damp-phlegm and depressed fire; use Erchen Tang (Two-Aged Phlegm Resolving Decoction) plus Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Zhizi (Gardeniae Fructus). If sudden cold reversal in hands and feet and sudden Jue with loss of consciousness occur, it mostly belongs to Phlegm-Fire, or sometimes initial Yin deficiency with sudden Yang heat; use lots of Shen Gao (Ginseng Paste) combined with Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice). For thin and weak persons, even without phlegm, fire is often abundant; taking Zhuli can also nourish Blood and descend Fire.