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Hawthorn fruit (Wumei) 300 pieces, Asarum (Xixin) 6 liang, Dried Ginger (Ganjiang) 10 liang, Coptis Rhizome (Huanglian) 16 liang, Angelica Sinensis Radix (Danggui) 4 liang, Prepared Aconite Root (Fuzi, peeled and processed) 6 liang, Sichuan Pepper (Shujiao, stir-fried until sweat appears) 4 liang, Cinnamon Twig (Guizhi) 6 liang, Ginseng Root (Renshen) 6 liang, Phellodendron Bark (Huangbai) 6 liang.

The above ten medicinal materials are crushed separately and sieved, then mixed uniformly. Soak Hawthorn fruit in vinegar overnight, remove the pits, steam them under five dou of rice until the rice is cooked. Pound the rice and Hawthorn fruit together into a paste, mix evenly with the powdered herbs, place in a mortar, add honey, and pound for two thousand strokes to form pills the size of paulownia seeds. Take ten pills before meals, three times a day, gradually increasing to twenty pills. Avoid consuming raw, cold, slippery foods, and spoiled food.

[Collected Commentaries]
Ke Qin stated: Among the Six Channels, only Jueyin disease (pathological changes of the Foot-Jueyin Liver Meridian) is difficult to treat. Its root is Yin, its manifestation is Heat, its nature is Wood, and its function involves Fire. One must suppress its dominant pathological mechanism and address the etiology first, employing methods such as astringing, dispersing, counteracting, or following, according to what is beneficial, to harmonize the Middle Qi and restore peace; this is the method for treating Jueyin disease. Jueyin occurs when two Yins reach their end, also known as "the extreme Yang of Yin," theoretically devoid of Heat. However, considering the principle of the conjunction of dark and bright phases, when Yin initially ends, Yang begins to generate. Therefore, the appearance of Heat in Jueyin disease is caused by Shaoyang Ministerial Fire. When Fire is excessive, Water becomes deficient, leading to Xiao Ke (wasting-thirst syndrome characterized by excessive thirst), sensation of Qi rushing up to strike the heart, and burning pain in the heart, because excess Qi transforms into Fire. When Wood is excessive, Wind is generated, and parasites arise from Wind transformation. When hungry, the Stomach is empty, and roundworms emerge smelling food odor, causing vomiting of worms; although hungry, there is no desire to eat. Zhang Zhongjing's formulas generally use Pungent, Sweet, and Bitter herbs as sovereign agents, avoiding Sour astringents. This formula uses them because Jueyin governs the Liver! The *Hongfan* states: "Wood bends and straightens, producing Sour." The *Neijing* states: "Wood generates Sour, and Sour enters the Liver." Using the great Sourness of Hawthorn fruit as the sovereign agent is to suppress its dominant pathology. Paired with Coptis Rhizome to drain Heart Fire and relieve pain, and assisted by Phellodendron Bark to nourish Kidney Water and relieve thirst, this addresses the etiology. Coptis and Phellodendron treat Jueyin disease; they are sufficient for Yang pathogens but insufficient for Yin pathogens. Sichuan Pepper, Aconite, Asarum, and Dried Ginger, all great Pungent-hot substances, are used together not only to treat Jueyin Yin pathogens but also because the Liver desires dispersion, using Pungent herbs to disperse it. Adding Cinnamon Twig and Angelica Sinensis is because the Liver stores Blood, seeking herbs corresponding to its affiliated organ. Mixing Cold and Hot drugs leads to discordant flavors; assisting with Ginseng Root harmonizes Middle Qi. Soaking Hawthorn fruit in vinegar seeks similar energies; steaming under rice utilizes grain Qi; adding honey to form pills and starting with small doses that gradually increase treats the root slowly. Roundworms are insects. Raw and cold substances combined with Damp-Heat Qi necessitate the mutual use of Cold and Hot drugs. Furthermore, chest irritability with vomiting of worms indicates that Coptis and Phellodendron are used as Cold for Heat application. Roundworms become quiet with Sour, subdue with Pungent, and descend with Bitter; this is indeed an excellent formula for treating parasites. Chronic diarrhea leads to deficiency; harmonizing Cold and Heat, and using Sour to astringe, will naturally stop the diarrhea.

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In Taiyang cold damage progressing for six or seven days, if the pulse is faint, hands and feet are cold, and there is restlessness, moxibustion should be applied to the Jueyin meridians. If the hands and feet do not warm up, the prognosis is fatal.

[Annotation]
This elaborates on the severe syndrome of Zang Jue (Visceral Cold Reversal) of the Jueyin. In Taiyang cold damage, after six or seven days, with a faint pulse, cold hands and feet, and restlessness, this represents a severe syndrome of Jueyin Yin pathogen. If not addressed early with strategies to reduce Yin and grow Yang, Yin Qi will gradually prevail, deepening the cold reversal and intensifying restlessness. Even with formulas like Evodia Decoction or Sini Decoction, it may be too late. Moxibustion on the Jueyin meridian should be used to unblock Yang. If hands and feet remain cold beyond the expected time, it indicates the loss of Yang, hence death.

[Collected Notes]
Fang Youzhi stated: Moxibustion unblocks Yang; if Yang does not return, death ensues.
Cheng Zhi stated: Six or seven days is the time for pathogenic factors to transmit to Jueyin. Faint pulse and cold reversal are not yet critical; the danger lies in restlessness, which indicates the exposure of weak Yang.
Cheng Yingmao stated: Faint pulse, cold reversal, and restlessness constitute the Zang Jue syndrome mentioned in previous clauses, which was absent in the preceding six or seven days.
Wang Hu stated: Restlessness indicates Yang deficiency struggling against itself, representing the impending collapse of True Yang within the viscera and the floating of Shen Qi, causing restlessness. Taichong (LR3) acupoint can be moxibusted, as it is the Shu-Stream point of the Foot-Jueyin Meridian. Located two cun posterior to the web margin of the big toe, or in the depression one-and-a-half cun back, three moxa cones can be applied.

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For cold hands and feet with a fine pulse nearly imperceptible, Danggui Sini Decoction is indicated. If the patient has chronic internal cold, Danggui Sini Decoction plus Evodia and Fresh Ginger is appropriate.

[Annotation]
This elaborates on the mild syndrome of Zang Jue of the Jueyin. Cold hands and feet with a fine, nearly imperceptible pulse are the pulse and symptom manifestations of Jueyin Yin pathogen transforming into Cold. However, the entire body skin is not cold, nor is there constant restlessness without respite. Thus, it is not comparable to Yang deficiency with Yin excess, so Dried Ginger and Aconite are not used. Instead, Danggui Sini Decoction is used to harmonize Jueyin and dispel Cold pathogens, regulating Ying and Wei to unblock Yang Qi. If the patient has chronic internal cold, Danggui Sini Decoction should be supplemented with Evodia and Fresh Ginger to directly target Jueyin and warm-disperse the cold.

[Collected Notes]
Cheng Zhi stated: Dried Ginger and Aconite are not used because there is no diarrhea, indicating it is not a pure Yin syndrome. Generally, in patients with a fine, nearly imperceptible pulse, Dried Ginger and Aconite could sufficiently injure Yin; therefore, purgatives are not lightly used, nor are warming herbs.
Zheng Zhongguang stated: Cold hands and feet with a fine, nearly imperceptible pulse are the external manifestations of Jueyin cold damage. Danggui Sini Decoction is the exterior-resolving formula for Jueyin cold damage.