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[From *Huoren Shu*] Li Gen Tang: Treats Qi rushing upward to the heart, with symptoms located directly at the epigastrium.
Herbs: Banxia (Pinelliae Rhizoma), Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Shengjiang (Zingiberis Rhizoma Recens), Fuling (Poria), Guizhi (Cinnamomi Ramulus), Huangqin (Scutellariae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Ganli Gen Baipi (Pruni Radicis Cortex Albus) (all in equal parts).
Preparation and Administration: Cut the herbs into small pieces. Take 5 qian per dose, decoct with water, and take warm.

Feeling hunger but having no desire to eat, and vomiting roundworms after eating, belongs to Jueyin Disease. (See discussion under "Qi Rushing Upward to the Heart".) Cold hands and feet, pulse suddenly becoming tight, mental restlessness, feeling hungry but unable to eat, indicates pathogenic factors lodged in the chest; Dou Chi San (Cucurbita Seed Powder) is suitable for inducing vomiting. (See discussion under "Jue".)
After purgation in Taiyang Disease, if sweating occurs, accompanied by fever without aversion to cold, fine and rapid Guan pulse, hunger in the abdomen but inability to eat from the mouth, and vomiting morning and evening, this is called Minor Reversal. (See discussion under "Fever".)
After purgation in Yangming Disease, if epigastric restlessness occurs, hunger without desire to eat, and only head sweating, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is suitable. (See discussion under "Restlessness".)

Qi rushing upward to the heart, heart pain, hunger without desire to eat, and vomiting roundworms belong to Jueyin Disease. (See discussion under "Qi Rushing Upward".) If the patient is quiet then becomes restless again, stops after a moment, vomits after eating, becomes restless again, and vomits roundworms, this is Roundworm Jue; Wumei Wan (Mume Pill) is suitable. (Formula discussion see "Jue".)
A patient with cold syndrome who undergoes diaphoresis again will have a cold stomach and must vomit roundworms. (*Huoren Shu* states: First administer Lizhong Wan, then administer Wumei Wan.)

In cases of contracting cold on two channels simultaneously, on the third day, Shaoyang and Jueyin are both diseased, resulting in deafness, retraction of the testicles, and Jue. (See discussion under Taiyin. Note: Deafness is a Shaoyang disease symptom; retraction of testicles and Jue are Jueyin disease symptoms.) In Shanghan, if Jue occurs between one or two days and four or five days, there must be fever. If there was prior fever, Jue will follow; deep Jue corresponds to deep heat, slight Jue corresponds to slight heat. Jue should be treated with purgation; if diaphoresis is used instead, oral lesions and redness will certainly occur. Cheng Wuji said: If Jue and cold extremities occur immediately upon onset, it is pathogenic invasion of Yin channels with insufficient Yang Qi; Sini Tang (Frigid Extremities Decoction) can be used to warm. If hands and feet go from hot to warm, or from Si Ni (Four Reversals) to Jue, it is transmitted channel pathogen; Sini San (Frigid Extremities Powder) is the main formula. This must be recognized to avoid error. (Sini Tang formula see "Diarrhea" below. Sini San formula see "Desire to Sleep".) Additionally, external symptoms must be distinguished. I once treated a middle-aged woman with aversion to cold but body heat and thirst, with a rapid, fine, and weak pulse, presenting first Jue then fever. Treatment with warming medicines aggravated the condition. Later, using half doses of Sini San combined with Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma), her Jue resolved, pulse became surging and large, and she recovered.

Cold hands and feet with a fine pulse nearly imperceptible indicate Danggui Sini Tang (Angelica Decoctio Frigidorum Extremorum).
Herbs: Gancao (Licorice Root), Tongcao (Tetrapanacis Medulla) (each 6 qian); Danggui (Angelicae Sinensis Radix), Guizhi (Cinnamomi Ramulus), Xixin (Asari Radix et Rhizoma), Shaoyao (Paeoniae Radix) (each 1 liang).
Preparation and Administration: Cut herbs. Take 5 qian per dose, add one jujube, decoct together, and take warm.
If the patient has chronic internal cold, Danggui Sini Tang plus Wuzhuyu and Shengjiang (Angelica Decoctio Frigidorum Extremorum plus Evodia and Fresh Ginger) is the main treatment. Add 2 liang of Wuzhuyu and 2.5 liang of Shengjiang to the original formula.
Vomiting with weak pulse, frequent clear urination, slight body heat with Jue is difficult to treat; Sini Tang (Frigid Extremities Decoction) is the main formula.
Shanghan with slippery pulse and Jue indicates internal heat; Baihu Tang (White Tiger Decoction) is the main formula.
Shanghan with hurried pulse and cold hands and feet can be treated with moxibustion. (*Mai Jing* states: Moxibustion is permissible; Shaoyin and Jueyin govern reversal.) In Shanghan lasting six or seven days, with faint pulse, cold hands and feet, and irritability, moxa the Jueyin points. If symptoms persist after moxibustion, death ensues.
Patients with cold hands and feet and sudden tight pulse have pathogenic factors knotted in the chest, fullness and irritability in the heart, hunger but inability to eat; the pathology is in the chest, vomiting is indicated; Gou Ti San (Melon Spine Powder) is suitable. ("Tight pulse" as "knotted pulse" is reasonable.) A pulse that beats fast but occasionally stops and resumes is called Cu (Hurried); a pulse that beats slowly but occasionally stops and resumes is called Jie (Knotted). In Jie and Cu pulses, the pulse pauses due to obstruction by pathogenic factors; moxibustion and vomiting are used to expel these pathogens.
Shaoyin Disease with body pain, cold hands and feet, and sinking pulse indicates Fuzi Tang (Aconite Decoction). (See discussion under "Desire to Sleep".) In Shanghan lasting five or six days, with head sweating, slight aversion to cold, cold hands and feet, epigastric fullness, lack of desire to eat, hard stool, and fine pulse, this is Yang Wei Jie (Minor Yang Knotting), involving both exterior and interior. Sinking pulse also indicates interior involvement. Sweating indicates minor Yang deficiency. If it were pure Yin knotting, there would be no exterior symptoms, all entering the interior; this is half-interior, half-exterior. Although the pulse is sinking and tight, it is not Shaoyin Disease, because Yin syndromes should not have sweating. Since there is head sweating, it is known not to be Shaoyin. Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be given; if discomfort persists, resolution comes with bowel movement.

[From *Ben Cao Yan Yi*] A person suffered from Shanghan for five or six days, with spontaneous head sweating, no sweat from the neck down, cold hands and feet, epigastric stuffiness, and constipation. Some saw cold limbs and sweating with stuffiness and mistook it for Yin Syndrome. I palpated his pulse as sinking and tight. I said: This symptom is indeed suspicious, but hard stool indicates it is not a deficiency knot; how can it be Yin? Although the pulse is sinking and tight, Shaoyin Disease mostly presents with spontaneous diarrhea, rarely constipation. This case is half-interior, half-exterior; administering Xiao Chai Hu Tang (Minor Bupleurum Decoction) resulted in recovery. Zhang Zhongjing's statement about Shanghan for five or six days with head sweating... until resolution with stool, refers precisely to this. Someone questioned: When pulse is tight in all positions with sweating, it is Yang collapse. This belongs to Shaoyin, which should not have sweat. Why? Because there is head sweating, we know it is not Shaoyin. How does head sweating indicate it is not Shaoyin? I said: This passage is where Zhang Zhongjing's reasoning is profound. Cold limbs, sinking-tight pulse, abdominal fullness look exactly like Shaoyin, but hard stool and head sweating rule out Shaoyin. The head is the convergence of the Three Yang channels; the Three Yin channels stop at the chest. Head sweating indicates Yang deficiency, hence "sweating is minor Yang," meaning Yin should not have sweat. If Shaoyin had head sweating, it would be fatal. Thus, Zhang Zhongjing's *Ping Mai Fa* states: The Heart is Fire. Understanding Shaoyin, those without head sweating can be cured; those with head sweating die. The Heart is Hand Shaoyin, the Kidney is Foot Shaoyin; they relate upper and lower. Only by interpreting the intent can one understand this.

In Shanghan, Jue with epigastric palpitations requires treating water retention first; Fu Ling Gan Jiang Tang (Poria and Ginger Decoction) should be taken, then treat the Jue. Otherwise, water will infiltrate the stomach and cause diarrhea.
Fu Ling Gan Jiang Tang
Herbs: Fuling (Poria), Guizhi (Cinnamomi Ramulus) (each 2 qian); Shengjiang (Zingiberis Rhizoma Recens) (3 qian); Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) (1 qian).
Preparation and Administration: Cut herbs, decoct with water, and take warm.
Shaoyin Disease with Si Ni (Four Reversals) or palpitations is treated with Sini San (Frigid Extremities Powder) plus Guizhi (Cinnamomi Ramulus). (Formula discussion see "Desire to Sleep".) In Shanghan with floating pulse, spontaneous sweating, frequent urination, irritability, slight aversion to cold, and leg cramps, giving Guizhi Tang (Cinnamon Twig Decoction) to attack the exterior is an error. This leads immediately to Jue, dry throat, irritability, and vomiting/reversal. Prepare Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) to restore Yang.
If Jue resolves and feet become warm, prepare Shaoyao Gancao Tang (Peony and Licorice Decoction) to extend the legs. If stomach disharmony causes delirium, give a small amount of Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction). If excessive sweating and burning needles were used, Sini Tang (Frigid Extremities Decoction) is the main formula.
Gancao Ganjiang Tang
Herbs: Gancao (Licorice Root) (4 liang), Ganjiang (Zingiberis Rhizoma) (2 liang).
Preparation and Administration: Cut herbs. Take 5 qian per dose, decoct with water, and take warm.
Shaoyao Gancao Tang
Herbs: Baishaoyao (White Paeonia Root), Gancao (Licorice Root) (each 2 liang).
Preparation and Administration: Cut herbs. Take 5 qian per dose, decoct with water, and take warm.
Tiaowei Chengqi Tang (Formula see "Fever"). Sini Tang (Formula see "Diarrhea").

Question: Symptoms resemble Yang Dan syndrome, but treatment worsened it, causing Jue, dry throat, calf cramps, and delirium. Master said: Hands and feet will warm at midnight, legs will extend, which happened. How do you know? Answer: Cun and Chi pulses are floating and large. Floating indicates Wind, Large indicates Deficiency. Wind generates mild heat; Deficiency causes calf cramps. Symptoms resemble Guizhi Tang pattern, so Fuzi (Aconite Root Lateralis Preparata) was added, and Guizhi increased to induce sweating; Fuzi warms meridians and restores Yang. For Jue, dry throat, irritability, Yangming internal knotting, and delirium, drink Gancao Ganjiang Tang again. At midnight, Yang returns, feet warm. If calves remain slightly cramped, give Shaoyao Gancao Tang again to extend them. Use Chengqi Tang to mildly loosen bowels to stop delirium; thus, recovery is known.
Shaoyin Disease with regurgitation after eating, inability to vomit, cold hands and feet, and string-taut slow pulse indicates vomiting is appropriate. (See discussion under "Vomiting".)
Diarrhea with Jue and tenesmus is treated with Sini Tang plus Xiebai (Allii Macrostemonis Bulbus). With faint pulse, Tongmai Sini Tang (Pulse-Resuscitating Frigid Extremities Decoction) or Baitong Tang (Opening the Yang Decoction). After warming, if pulse is absent, Baitong Tang plus Zhu Danzhi (Pig Gallbladder Bile). After sweating, if cramping occurs, Sini Tang. After purgation, if throat is uncomfortable, Mahuang Shengma Tang (Ephedra and Corydalis Decoction). (Formula discussion see "Diarrhea".)
Vomiting and diarrhea with fever, aversion to cold, sweating, and Jue belong to Huoluan (Cholera-like disorder); Sini Tang (Frigid Extremities Decoction) is suitable. Vomiting and diarrhea with extreme irritability and Jue belong to Shaoyin; Wuzhuyu Tang (Evodia Decoction) is suitable. If vomiting and diarrhea stop, pulse is faint and nearly absent with Jue, Tongmai Sini Tang plus Zhu Danzhi (Pig Gallbladder Bile) is used. (Formula discussion see "Vomiting and Diarrhea".)
Heatstroke with dry mouth and thirst: See Heatstroke section.
Shanghan with faint pulse and Jue, progressing to skin cold and constant restlessness after seven or eight days, is Zang Jue (Visceral Jue), not Hui Jue (Roundworm Jue). Hui Jue patients vomit roundworms; they are quiet then intermittently restless due to visceral cold causing roundworms to ascend to the diaphragm. Restlessness stops after a moment. Vomiting and restlessness after eating occur because roundworms smell food and emerge, leading to self-vomiting of roundworms. Hui Jue is treated with Wumei Wan (Mume Pill).
Wumei (Mume Fructus) (75 fruits), Xixin (Asari Radix et Rhizoma), Fuzi (Aconiti Lateralis Radix Preparata, processed, peeled), Renshen (Ginseng Radix et Rhizoma), Huangbai (Phellodendri Cortex), Guizhi (Cinnamomi Ramulus) (each 1 liang), Ganjiang (Zingiberis Rhizoma) (2 liang), Huanglian (Coptidis Rhizoma) (4 liang), Shujiao (Zanthoxyli Pericarpium, stir-fried, sweat removed) (1 liang), Danggui (Angelicae Sinensis Radix).
Grind the ten herbs into fine powder. Soak Wumei in vinegar overnight, remove pits, steam until cooked, pound into paste, mix with powder, place in mortar, add refined honey, pound three thousand times, form pills the size of paulownia seeds. Take ten pills before meals, three times daily, gradually increasing to twenty pills. Avoid raw, cold, and slippery foods.

All Jue syndromes occur when Yin and Yang Qi fail to connect smoothly, resulting in cold extremities.
In Shanghan, if Jue lasts four days and fever three days, then Jue five days, the disease progresses due to excess cold and deficient Yang. If fever lasts four days and Jue three days, with less Jue and more heat, the disease should resolve spontaneously. If heat persists from day four to seven, pus and blood will appear in stool later. If Shanghan starts with six days of fever and nine days of Jue with diarrhea, the patient should not eat. If they can eat now, fear Chu Zhong (Middle Elimination/False Appetite). Feed Suobing (noodles); if no fever follows, stomach Qi remains, and recovery is certain. Fear that stomach heat came and went. Check pulse in three days; if heat continues, recovery is expected at midnight of the next day. Originally fever six days, Jue nine days, plus three more days of fever equals nine days, matching the Jue duration, hence recovery at midnight. If pulse is rapid and heat persists after three days, excess heat will cause abscesses/pus. If Jue and fever each last five days, and Jue does not recur on the sixth day, it resolves spontaneously. Jue does not exceed five days; since heat lasted five days, recovery is known. In Shanghan with slight heat and mild Jue (cold fingertips), silence, lack of desire to eat, irritability for several days, clear urine, and white color, heat is eliminated, desire to eat returns, and disease resolves. If Jue with vomiting and chest/diaphragm fullness occurs, blood in stool will follow later. Fullness and pain in the lower abdomen with Jue indicates Cold Knotting at Guanyuan point. (See discussion under "Lower Abdominal Pain".) Shaoyin Si Ni with aversion to cold, curled posture, absent pulse, irritability without restlessness, is fatal. (See discussion under "Desire to Sleep".)
Shaoyin Disease with only Jue and no sweat: forcing sweating will disturb blood. (See discussion under "Desire to Sleep".) All Si Ni and Jue syndromes contraindicate diaphoresis; so do all deficiency syndromes. In Shanghan lasting five or six days, without Chest Binding, soft abdomen, weak pulse, and Jue, purgation is contraindicated; this is Blood Loss, and purgation leads to death.
All the above Jue reversals contraindicate purgation, except the previously mentioned case of prior fever leading to Jue, where Jue requires purgation; if sweating was used instead, that is the exception: purgation is suitable, sweating is contraindicated.