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Zhang Zhongjing's concept of "Jue Ni" (Jue and Ni) differs from that stated in the *Huangdi Neijing* (Yellow Emperor's Inner Canon). Zhang Zhongjing discusses it solely in the context of Shanghan (Cold Damage), stating that when Yin pathogens directly invade and cold enters the Three Yin meridians causing cold hands and feet, it is called Cold Jue; when Yang pathogens transmit through the meridians and heat enters the Three Yin meridians causing cold hands and feet (due to deep-seated heat causing Yang Qi to sink internally and fail to reach the four limbs, resulting in coldness), it is called Heat Jue. This primarily refers to external pathogens, where both cold and heat syndromes manifest as cold hands and feet. In contrast, the *Neijing* refers to internal injuries, describing Jue Ni as a condition of upper excess and lower deficiency, where Qi and Blood rebel upward, causing sudden collapse and fainting ("Jue" means exhaustion, "Ni" means upward rebellion, indicating the depletion of Zheng Qi with upward rushing and impending collapse). Furthermore, the *Neijing* distinguishes between Heat Jue, which presents with hot hands and feet, and Cold Jue, which presents with cold hands and feet, highlighting such significant differences. The Cold Jue, Heat Jue, Hui Jue (Ascaris Jue), and Zang Jue (Viscera Jue) mentioned by Zhang Zhongjing are detailed in the *Shanghan Lun* (Treatise on Cold Damage); this chapter only elaborates on the discussions found in the *Neijing*.

The *Classic* states: "When essence is depleted internally leading to Jue, aphasia and flaccid paralysis occur, which is due to Kidney deficiency." (See Stroke Section.) It also states: "When Qi and Blood rush together to the upper part, Jue occurs, potentially leading to sudden death; if Qi returns downward, life is preserved; if it does not return, death ensues." It further states: "When the pulse is rapid like panting, it is called Bao Jue (Sudden Jue), characterized by unconsciousness and inability to speak." (This corresponds to stroke with loss of consciousness.) It states: "When Yang Qi rebels to the upper part, Fire shines alone; when Yin Qi rebels to the lower part, the feet become cold." It states: "Human Yang Qi, when subjected to excessive mental or physical labor, becomes hyperactive (manifesting as high-pitched breathing and panting). If Essence is exhausted (Heat consumes Kidney Water), and this accumulates over time into summer, it leads to Jian Jue (Frying Jue). 'Pi Ji' implies accumulation like folds in clothing. Accumulated heat reaching summer makes one feel as if being fried or boiled, corresponding to heatstroke." It states: "Great anger causes Blood to stagnate in the upper part (Blood follows Qi upward and congests), leading to Bo Jue (Pressing Jue). 'Bo' means pressure. This indicates chaotic Qi and Blood in the chest pressing against each other, causing Jue, corresponding to Qi stagnation syndrome." It states: "Hemiplegia, flaccidity, and Jue are diseases of wealthy individuals caused by rich and greasy food." (Corresponding to Food Stagnation Syndrome.) It states: "The Chong Mai (Penetrating Vessel) is the Sea of the Five Zang-Fu Organs. Its ascending branch emerges from the Kangsang (pharynx/nasopharynx region), permeates the Yang meridians, and irrigates the Jing (Essence); its descending branch joins the Shaoyin Meridian, permeates the Three Yin meridians, and descends along the dorsum of the foot. Therefore, if collateral vessels are obstructed, the pulse at the dorsum of the foot ceases; if the pulse ceases, Jue occurs, and Jue leads to coldness." (See *Lingshu: Ni Shun Fei Shou Chapter*. Note: The Chong Mai is the convergence point of all meridians throughout the body, hence also called the Sea of Blood. It originates from the Baozhong (Uterus/Essence Chamber) along with the Ren and Du meridians. Baozhong is the Dantian; in women, it is called Bao, and in men, Jing Shi. It is the root of life and nature. Once the root fails, all meridians fail. Thus, sudden Jue and collapse are not merely caused by a single meridian or organ.) It states: "Pathogens invading the collaterals of the Hand and Foot Shaoyin, Taiyin, and Foot Yangming meridians—these five collaterals converge in the ear and ascend to connect with the left corner of the head (left frontal angle). If these five collaterals are exhausted (meaning pulses are blocked by pathogens and do not reach), the person's body pulses may move but the form is unconscious (described as resembling a corpse). This state resembles a dead body and is called Shi Jue (Corpse Jue). [Treatment:] Burn one square cun of hair from the left frontal angle to ash (preserving its properties), drink with a cup of fine wine (Blood remainder promotes blood circulation, wine promotes Qi flow; when Qi and Blood circulate, consciousness returns). For those who cannot swallow (due to lockjaw), force-feed the mixture, and recovery will be immediate." (This corresponds to Evil Invasion Syndrome.)

The above scriptural passages are consistent with those in the *Zhu Zhong Pian* (Chapter on Various Collapses). Thus, the Jue Ni mentioned in the *Classic* clearly refers to sudden collapse and fainting, initially unrelated to whether the hands and feet are cold or hot. This is fundamentally different from the descriptions in the *Shanghan Lun*. However, the *Classic* also discusses Jue based on hand and foot temperature, as detailed below.

The *Jue Lun* (Treatise on Jue) states: "When Yang Qi declines in the lower part, it results in Cold Jue. Since Yin Qi originates from the interior of the five toes and gathers at the knees, when Yin Qi prevails, coldness spreads from the toes up to the knees. Even if a person is physically strong, if they overexert themselves during autumn and winter (times when Yang Qi should be stored, but wasteful consumption depletes it, as if stolen), Yang Qi is damaged and Yin Qi remains dominant, causing cold hands and feet. When Yin Qi declines in the lower part, it results in Heat Jue. Since Yang Qi originates from the exterior of the five toes, and Yin meridians gather at the soles and arches of the feet, when Yang Qi prevails, the soles become hot. This often happens when a person drinks heavily or engages in sexual activity after a full meal. Qi gathers in the Spleen and cannot disperse (food and alcohol remain in the Stomach, while sexual activity damages Essence and Jing, impairing transportation and transformation). The Qi of alcohol and grain food struggle within, generating intense heat in the center that spreads throughout the body. Internal heat causes dark urine. As Kidney Qi declines daily (Kidney Water is consumed by Fire), Yang Qi becomes dominant, causing hot hands and feet."

Examining this scripture, Heat Jue presents with hot hands and feet, and Cold Jue presents with cold hands and feet. This differs from Zhang Zhongjing's view that both cold and heat Jue present with cold hands and feet.

Treatment Methods: For Jian Jue (Frying Jue), use Renshen Guben Wan (Ginseng Root-Solidifying Pill). For Bo Jue (Pressing Jue), use Puhuang Tang (Pollen Typhae Decoction). For Shi Jue (Corpse Jue), use Ershisi Wei Liqi Yin (Twenty-Four-Ingredient Qi-Circulating Decoction) or Suhexiang Wan (Styrax Pill) (see Zhu Zhong Pian), and blow Changpu Mo (Acorus Rhizome Powder) into the nose. For Cold Jue, use Sini Tang (Four Reversal Decoction) or Liuwei Fuzi Tang (Six-Ingredient Aconite Decoction), moxa Yangfu and Juegu acupoints, or warm compress the legs to the knees with a half-wine, half-water mixture. For Heat Jue, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (see Deficiency Damage Section), and soak hands and feet three times daily in warm medicinal liquid. There is also Tan Jue (Phlegm Jue), which Zhu Danxi in the *Stroke Section* attributes to Phlegm generated by Damp-Heat. If Cold Phlegm confuses the mind, causing cold extremities and sudden collapse, use Jiangfu Tang (Ginger and Aconite Decoction) (see Cold Damage Section). Additionally, Qi Jue is divided into Qi Deficiency and Qi Excess types. The deficiency type corresponds to Li Dongyuan's description in the *Stroke Section* of being caused by Qi deficiency; the excess type corresponds to the discussion in the *Qi Section*. There is also Xue Tuo Zhi Jue (Jue due to Blood Collapse) (caused by severe vomiting or uterine bleeding, often leading to sudden collapse). Pinch the Renzhong acupoint first, or burn charcoal and pour vinegar to fumigate the nose to consolidate Qi, then urgently administer a decoction of 1–2 liang of Renshen (Ginseng). Subsequently, treat according to the Blood Syndrome section. There is also Se Tuo Zhi Jue (Jue due to Essence/Libido Collapse), occurring immediately after excessive sexual activity leading to collapse and death. Urgently pinch Renzhong, have a woman hold the patient firmly, and perform mouth-to-mouth resuscitation to transfer warm air; do not release. Immediately moxa Qihai for dozens of moxibustion units, and drink Dushen Tang (Single Ginseng Decoction). If collapse occurs after two to three days (Essence lost first, then Qi collapses), also moxa Qihai and drink Ginseng Decoction. For Jiu Jue (Alcohol Jue), use Gegua Jie Cheng Tang (Kadsura Flower Decoction for Relieving Hangover) (see Food and Drink Injury Section. Heavy drinking causes upper excess and lower deficiency, leading to sudden collapse). For Shi Jue (Food Jue), caused by overeating combined with emotional disturbance, leading to stagnant Stomach Qi and Yang Qi rebelling upward. The upper body is hot, the lower body is cold (corresponding to Food Stagnation Syndrome with pulses present in the upper body but absent in the lower body), and the patient feels cold even near a stove. Misapplication of warming tonics will cause death. This is Yangming Qi rebellion, hence the hands are not cold. Use Pingwei San (Calm the Stomach Powder) or Jiajian Baohe Wan (Modified Harmonize the Stomach Pill) (see Food Injury Section).