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Jueyin (Liver and Pericardium) is the zang organ where yin energy ends and yang energy begins, and it stands in exterior-interior relationship with Shaoyang (Gallbladder and Sanjiao). Therefore, when disease pathogens invade this meridian, they present as a mixture of yin and yang, and a confusion of cold and heat; after invading the meridian, the pathogens transform differently according to the individual's constitution. If the person is predisposed to heat, the pathogens transform along the yang aspect, thus manifesting yang syndromes such as Xiao Ke (excessive thirst), Qi Shang Zhuang Xin (sensation of qi rushing up to strike the heart), Xin Zhong Teng Re (pain and burning sensation in the heart region), Hui Jue (Jue syndrome caused by roundworms), oral ulcers, sore throat, Hou Bi (obstruction and pain in the throat), abscesses with pus, and bloody stools. Conversely, if the person is predisposed to cold, the pathogens transform along the yin aspect, thus manifesting yin syndromes such as coldness of the hands and feet, a faint pulse nearly imperceptible, coldness of the skin, Zang Jue (visceral Jue syndrome), diarrhea, and Chu Zhong (return of appetite in critical illness indicating impending death). Thus, when Shaoyang disease fails to resolve and transmits to Jueyin, the condition becomes critical; when Jueyin disease recedes and transfers back to Shaoyang, recovery is imminent. This illustrates the waxing and waning of yin and yang, hiding great crisis. Herein, the subtle principles of transformation according to yin and yang, and the alternation of Jue (cold limbs) and Re (heat), are elaborated in detail, so that clinicians may have essential guidelines for diagnosis and treatment.

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The general outline of Jueyin disease includes: Xiao Ke (excessive thirst), sensation of qi rushing up to strike the heart, pain and burning sensation in the heart region, hunger without desire to eat, vomiting of roundworms upon eating; if purgatives are misused, it leads to unremitting diarrhea.

[Annotation]
This clause summarizes the general outline of Jueyin disease. Jueyin is the zang organ where yin ends and yang begins. When pathogens invade its meridian, they can transform into cold from yin or heat from yang; hence, the disease presents as a mixture of yin and yang, and a confusion of cold and heat. "Xiao Ke" refers to drinking much water but producing little urine, which results from Jueyin heat transforming and consuming body fluids. The Jueyin meridian originates at the tip of the big toe, runs along the inner thigh into the genital region, circles the genitals, reaches the lower abdomen, penetrates the diaphragm, and connects with the heart. If heat pathogens ascend reversely along the meridian to the diaphragm, it causes the sensation of qi rushing up to strike the heart and pain/burning in the heart region. "Hunger without desire to eat" does not mean no desire to eat; rather, eating triggers roundworms causing vomiting, so although hungry, one avoids eating, and eating leads to vomiting roundworms. Since there is excessive thirst and inability to eat, what remains in the stomach is only water and heat! If one mistakenly assumes this pain caused by Jueyin heat and moving roundworms is the excess pain of Yangming transmission and uses purgatives, the stomach qi will become even more deficient, inevitably leading to unremitting diarrhea.

[Collected Annotations]
Cheng Wuji stated: When pathogens transmit from Taiyang to Taiyin, abdominal fullness and dry throat occur, but thirst has not yet formed; reaching Shaoyin, dry mouth and tongue with thirst occur, but Xiao Ke has not yet formed; reaching Jueyin, Xiao Ke forms because the pathogenic intensity is sufficient to consume water. Zhang Qingzi also said: I have seen several cases of Jueyin Xiao Ke where the tongue was entirely red, limbs were cold, pulse was faint, and thirst was severe. Treatments with Bai Hu Tang (White Tiger Decoction) and Huang Lian Tang (Coptis Decoction) failed to save them. This is because Jueyin Xiao Ke involves mixed cold and heat pathogens, unlike pure yang hyperactive heat syndromes.

Wei Litong stated: This further explains the harm of heat pathogens transmitted to Jueyin, listing symptoms to prohibit misuse of purgatives. Pathogens transmitting to Shaoyin constitute the interior of the interior; transmitting from Shaoyin to Jueyin represents the extreme end of the three Yin meridians. At the point where yin ends, pathogens have nowhere else to transmit and instead use Shaoyang as an exit for ascending and descending. Shaoyang disease has no purgative method; similarly, Jueyin yin pathogens have no purgative method, making purgation clearly erroneous. Marking "Xiao Ke" first implies that while all heat causes thirst, cold-dampness obstructing righteous qi can also cause thirst; however, such thirst involves wanting to drink but unable to drink much. It is rare to see thirst followed by immediate consumption and renewed thirst (drink-consume-thirst cycle). Such Xiao Ke undoubtedly indicates heat pathogens transmitted to Jueyin.

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In Jueyin disease, if the patient desires water, giving small amounts will lead to recovery.

[Annotation]
Desire for water in Jueyin disease indicates yang returning and seeking harmony, a sign of resolution. One should give small amounts to harmonize the Stomach. Once the Stomach is harmonized, sweating occurs, and recovery follows naturally. Giving too much water causes it to stagnate and soak into the Stomach, inevitably leading to Jue (cold limbs) and diarrhea.

[Collected Annotations]
Zhang Lu stated: Yang qi is about to recover, hence the desire for water. Giving small amounts is necessary because yin pathogens are just beginning to dissipate and yang qi has not fully returned. Indulging in drinking without digestion risks fluid retention.

Wang Hu stated: Jueyin disease includes Xiao Ke, which does not mention spontaneous cure because intense heat scorches fluids; drinking cannot overcome the dryness, indicating deep-seated pathogens and unresolved disease. In contrast, the desire for water and cure upon giving water in this clause indicates mild heat and pathogens moving outward for resolution. These two situations are distinct.

In Shanghan (Cold Damage), if there is Jue (cold limbs) with palpitations below the heart, one should first treat the water retention by administering Fu Ling Gan Cao Tang (Poria and Licorice Decoction), and then treat the Jue. Otherwise, water soaking into the Stomach will cause diarrhea.

[Commentary]
Under "Jue with palpitations below the heart," the phrase "due to excessive water intake" should be inserted. Without these four characters, it would be Jue and palpitations due to yin excess, not water retention. How could one know it is water and advise treating water first?

[Annotation]
Shanghan presenting with Jue and palpitations below the heart, without thirst or desire to drink, indicates Jue and palpitations due to yin excess. If caused by excessive water intake, it indicates Jue and palpitations due to water retention. Therefore, one should first treat the water, then the Jue, using Fu Ling Gan Cao Tang (Poria and Licorice Decoction), which is Gui Zhi Gan Cao Tang (Cinnamon Twig and Licorice Decoction) plus Fu Ling (Poria) and Sheng Jiang (Fresh Ginger). Gui Zhi and Gan Cao tonify yang deficiency; assisting with Sheng Jiang disperses external cold externally, reversing Jue. As the chief herb, Fu Ling unblocks water passages internally, calming palpitations. This is the treatment of treating water before Jue. Generally, water retention presents with difficult urination. If treated otherwise, retained water soaks into the Stomach, causing diarrhea.

[Commentary]
In the Taiyang chapter of Shanghan Lun, sweating with unresolved exterior and difficult urination, and this case of unresolved exterior with Jue and palpitations below the heart, both use Fu Ling Gan Cao Tang. Although manifestations differ, both lack interior heat, have unresolved exterior, and feature water retention. Thus, one uses it to harmonize Ying and Wei to promote urination, and the other to release the exterior and unblock yang to promote urination; both are applicable. Although this case does not explicitly state difficult urination, the implication is present. If urination were free, water would not retain, and Jue/palpitations would belong to yin-cold, making exterior-releasing and diuretic methods inappropriate.

[Collected Annotations]
Fang Youzhi stated: *Jin Gui Yao Lue* says: Water retaining below the heart causes palpitations when severe; thus, palpitation indicates severe water, and Jue indicates severe cold. Cold is formless, water has form. Removing water eliminates cold, and Jue heals. Water entering the Stomach moistens the earth (Spleen).

Yu Chang stated: In the Taiyang chapter, excessive drinking causes palpitations below the heart. Thus, this Jue with palpitations below the heart is clearly caused by drinking. Before water soaks into the Stomach, use Fu Ling Gan Cao Tang to treat water, clearing the source of diarrhea, then treat Jue, preventing Jue and diarrhea from occurring together.

Cheng Yingmao stated: Jue caused by cold and water retention is verified by palpitations below the heart. Jueyin cases often arise from Xiao Ke; water is the root, cold is the branch. Not treating water first, nor preventing water from soaking into the Stomach, how dare one use purgatives?

Wang Hu stated: Jue with palpitations below the heart is clearly due to excessive drinking. Cold-fluid retains below the heart, preventing chest yang from circulating, causing Jue. This is not external cold. The method requires treating water first with Fu Ling Gan Cao Tang; the method for treating Jue is included therein. Once water is removed, Jue resolves. Otherwise, failing to treat water allows it to soak into the Stomach, causing diarrhea.

Wu Renju stated: Qi and pulse flowing abnormally is called rebellion, named Jue. Jue varies by phlegm, excess, cold, heat, qi, and water; this case is due to water. Water qi not following its path ascends coldness to the heart causing palpitation. Treating water removes palpitation, and Jue returns. If not, severe water saturates the earth (Spleen), causing diarrhea.

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In Shanghan, a faint pulse with Jue, progressing to seven or eight days with coldness of the whole body skin, and restlessness without any moment of peace, is Zang Jue (Visceral Jue), not Hui Jue (Roundworm Jue). Patients with Hui Jue typically vomit roundworms. The current patient is quiet but occasionally irritable; this indicates Zang Han (Visceral Cold). Roundworms ascending into the diaphragm cause irritability, which stops after a short while. Vomiting and irritability after eating occur because roundworms emerge smelling food odor; the patient will likely vomit roundworms spontaneously. Hui Jue is primarily treated with Wu Mei Wan (Mume Pill), which also treats chronic diarrhea/dysentery.

[Commentary]
The character "Ci" (this) in "Ci wei Zang Han" should be "Fei" (not). If it were "Ci," it would describe Zang Jue, inconsistent with the differentiation of Hui Jue.

[Annotation]
The first clause generally discusses Jueyin yang pathogens transforming into heat; this clause details Jueyin yin pathogens transforming into cold, clarifying the differences between Zang Jue and Hui Jue, and providing treatments. Faint pulse and Jue are Jueyin pulse/syndrome signs. After seven or eight days without warming, cold hands/feet, and generalized skin coldness with constant restlessness, this is Zang Jue due to Jueyin yang deficiency and yin excess, not the mixed yin-yang Hui Jue. If Hui Jue, the patient vomits roundworms. The current patient is quiet with occasional irritability, unlike the constant restlessness of Zang Jue. Knowing this is not restlessness from Zang cold, but roundworms disturbing the diaphragm, the irritability stops briefly. Eating triggers vomiting and irritability because roundworms move upon smelling food. Roundworm movement causes vomiting, expelling the worms. Hence, "the patient will likely vomit roundworms." Hui Jue is treated with Wu Mei Wan, which also treats chronic diarrhea, because its sour, bitter, acrid, and warm properties combine cold and heat resolving agents to address mixed yin-yang and confused cold-heat pathogens. Zang Jue is treated with Wu Zhu Yu Tang. Cases involving Shaoyin are treated with Si Ni Tang (Four Counterflow Decoction), Tong Mai Si Ni Tang (Pulse-Unblocking Four Counterflow Decoction), or Fu Zi Tang (Aconite Decoction); clinicians should judge accordingly.

[Collected Annotations]
Fang Youzhi stated: Faint pulse and Jue are general statements. Skin coldness indicates not just hands/feet are cold, showing internal sinking of yang. Zang Jue indicates pathology in the viscera, not the meridians.

Yu Chang stated: Faint pulse and Jue indicate declining yang, but do not confirm Zang vs. Hui Jue. Only skin coldness with constant restlessness confirms Zang Jue. Zang Jue treated with Si Ni Tang and moxibustion; if Jue does not reverse, death ensues. Hui Jue presents with intermittent Jue and irritability, not necessarily fatal, but if it progresses to gastric yang depletion, death occurs.

Cheng Zhi stated: Jue differs between Zang and Hui. Zang Jue is failure of Kidney yang; Hui Jue is cold limbs with vomiting roundworms, indicating failure of Stomach/Fu yang. In Hui Jue, roundworm movement causes irritability with quiet periods, unlike Zang Jue's constant restlessness. This is Stomach yang pathology unrelated to Kidney yang; though Jue is similar, syndromes differ.

Cheng Yingmao stated: Faint pulse and Jue are images of pure yin, evident in pulse; skin coldness after 7-8 days is image of no yang, evident in form. Extreme yin generates restlessness without peace; this is originally Shaoyin Zang Jue, an untreatable syndrome, not inherent to Jueyin. Vomiting roundworms is a primary Jueyin symptom; linking Hui Jue clarifies conditions where yin and yang fail to connect smoothly. Naming Wu Mei Wan "calming roundworms" actually calms the Stomach. Its indication for chronic diarrhea shows that syndromes of disconnected yin-yang, Jue, and diarrhea can all be managed by this formula.

Lin Lan stated: Yang irritability is mild; yin restlessness is severe. Using "restlessness" for Zang Jue and "irritability" for Hui Jue highlights their differing prognoses. Zang Jue involves impending yang collapse and visceral qi exhaustion with struggle, making it a fatal syndrome. Hui Jue involves deficient-cold visceral qi, not yet exhausted. Cold visceral qi makes roundworms restless in their palace; deficient qi makes roundworms seek food and emerge. Hence, vomiting roundworms is characteristic.