Library

What is the reason for cold and heat in Jue syndrome? (The term "Jue" refers to reversal or counterflow. When Qi flows reversely, it causes chaos, leading suddenly to dizziness, collapse, or loss of consciousness, which is named Jue. Jue originating from the feet marks the beginning of the attack; severe cases involve sudden collapse and unconsciousness, while mild cases recover gradually, and severe ones may result in immediate death, making it a critical condition. Later generations incorrectly referred to cold or hot extremities as Jue, and some even misidentified Hong Kong foot (a lower limb disease) as Jue, which is highly erroneous. Although Zhang Zhongjing distinguished between Cold Jue and Heat Jue, he was referring specifically to the extremities to differentiate cold and heat patterns in Shanghan (Cold Damage), not defining Jue itself. In sudden Jue, the patient cannot speak; when Blood and Qi rush upward together, it forms Great Jue, causing sudden apparent death. If Qi returns, the patient lives; if not, they die. When the meridians of Foot Shaoyin, Taiyin, and Foot Yangming are all exhausted, the body feels heavy and the form becomes insensate; this state resembling a corpse is called "Corpse Jue." Such conditions far exceed mere cold/hot extremities or Hong Kong foot. Nowadays, people often fail to recognize Jue syndrome and mistakenly diagnose it as Stroke. Stroke typically involves injury to the meridians, whereas Jue directly results from the depletion of Essence and Qi internally. The exterior-interior and deficiency-excess aspects must be differentiated. Incorrect terminology and treating Jue with wind-dispelling methods cause significant harm to medicine. By comparing Wind and Jue side by side, students should clearly understand this.)

When Yang Qi declines at the lower part, Cold Jue occurs; when Yin Qi declines at the lower part, Heat Jue occurs. (The vital energy of all things rises from below; thus, the decline of Yin and Yang Qi at the lower level gives rise to Cold and Heat Jue.)

Heat Jue manifests as heat starting from the soles of the feet because Yang Qi originates from the dorsal aspect of the five toes, while Yin meridians converge at the soles and gather in the sole center. Therefore, when Yang Qi prevails, the soles become hot. (The distal ends of the toes are termed "biao" (exterior/surface), where the three Yang meridians originate. The soles and centers of the feet are where the three Yin meridians gather. If Yang Qi prevails, Yin Qi becomes deficient, allowing Yang to invade Yin territories, so Heat Jue always begins at the soles. This is why patients with Yin deficiency often experience heat in the soles.)

Cold Jue manifests as cold starting from the five toes and extending up to the knees because Yin Qi originates from the plantar aspect of the five toes, gathers below the knees, and accumulates above them. Thus, when Yin Qi prevails, coldness spreads from the toes to above the knees. This coldness does not come from outside but arises from within. ("Li" refers to the interior, i.e., the soles. If Yin Qi prevails, Yang Qi becomes deficient and cannot overcome Yin, resulting in cold. Jue always starts at the toes and ascends with coldness. However, this cold is not exogenous but endogenous. Hence, patients with Yang deficiency invariably have cold extremities starting from the toe tips.)

Why does Cold Jue occur due to such imbalance? (When Cold Jue is about to manifest, the hands and feet feel cold first.)

The anterior yin region is the gathering place of the Zongjin (major sinews), where the Taiyin and Yangming meridians intersect. (The anterior yin refers to the genitalia. Zongjin denotes the convergence of numerous sinews, including those of the three Yin meridians, Yangming, Shaoyang, Chong, Ren, Du, and Qiao meridians. Here, only Taiyin and Yangming are mentioned because they emphasize the organs of water and grain. The Stomach is the sea of water and grain and blood/qi, moistening the Zongjin, serving as the meeting point of Yin and Yang sinews at the Qichu acupoint, with Yangming acting as the leader. This is highlighted to explain the following text.)

In spring and summer, Yang Qi is abundant and Yin Qi is scarce; in autumn and winter, Yin Qi is prosperous and Yang Qi declines. (This follows the natural laws of heaven and earth.) A robust person who overexerts themselves during autumn and winter depletes their lower Qi, causing it to struggle upward without recovery. Essence overflows downward, and pathogenic Qi follows it upward. (Robust individuals rely on their strength but may indulge in sexual activity during Yin-dominant seasons, depleting Kidney essence. Deficiency of essence below leads to an upward struggle of lower Qi. Excessive consumption outpaces generation, preventing recovery. Essence overflow leads to Qi loss; Qi loss leads to Yang deficiency; Yang deficiency allows Yin excess to become pathogenic, causing cold Qi to rebel upward.)

Qi becomes constrained in the middle jiao. (Qi here refers to the essence and pathogenic Qi mentioned earlier. Essence originates from water and grain, transformed by the Spleen and Stomach. Thus, Cold Jue, upward struggle of lower Qi, and essence overflow are all caused by Qi constrained in the middle. While water and grain reside in the Stomach and Mingmen is in the Kidney, essence transformation depends on the Stomach, and Earth's Yang root lies in Mingmen. Yin and Yang are interlinked; hence, "Jue starts from below" and "Qi is constrained in the middle" illustrate their mutual dependence.)

When Yang Qi declines, it cannot nourish the meridians. As Yang Qi diminishes daily, Yin Qi remains alone, causing coldness in the hands and feet. (Yang Qi here refers to Yangming Stomach Qi. The four limbs receive Qi from the Stomach. Middle-jiao Yang deficiency fails to nourish the meridians, resulting in cold extremities.)

How does Heat Jue occur? (When Heat Jue is imminent, the hands and feet are hot.)

Wine enters the Stomach, filling the Luo (collateral) vessels while leaving the Jing (main) vessels empty. (Wine is a liquid of cooked grains with fierce and rapid Qi, filling the collaterals first. Full collaterals and empty meridians indicate that wine damages Yin, leading to Yang excess and Yin deficiency.)

The Spleen transports fluids for the Stomach. When Yin Qi is deficient, Yang Qi enters inwardly. Internal Yang Qi disrupts Stomach harmony, leading to exhaustion of essential Qi, which then fails to nourish the four limbs. (Since the Spleen transports fluids, wine entering the Stomach affects the Spleen. Damp-heat in the Spleen causes Spleen Yin deficiency and isolated Yang hyperactivity, disrupting Stomach harmony. Spleen-Stomach dysfunction exhausts essential Qi, failing to nourish the limbs.)

Such individuals often engage in sexual activity after heavy drinking or full meals. Qi aggregates in the Spleen and cannot disperse. Wine Qi and Grain Qi contend, generating intense heat in the center, spreading throughout the body, causing internal heat and dark urine. Wine Qi is fierce and dominant, causing daily decline of Kidney Qi and isolated Yang excess, leading to hot extremities. (Frequent drunkenness and sexual activity damage both Spleen and Kidney, causing Yin deficiency and hot extremities. Cold Jue arises from overexertion in winter depleting Yang Qi; Heat Jue arises from drunkenness/sexual activity exhausting Essence Qi. Both stem from alcohol and lust damaging true Yuan Qi, explaining the severity of Jue.)

Jue may cause abdominal fullness, sudden unconsciousness, or recovery after half a day to a day. This is because excessive Yin Qi above leads to lower deficiency, causing abdominal distension. (Yin Qi prevailing above fails to secure the lower part, causing lower deficiency. Lower Yin deficiency impairs Spleen-Kidney transformation, leading to abdominal fullness.) Excessive Yang Qi above causes lower Qi to merge and ascend rebelliously, creating chaotic Yang Qi and unconsciousness. ("Zhong" means merging. Pathogenic Qi refers to abnormal Qi flow. Yang excess above forces lower Qi upward, causing rebellion and chaos, leading to loss of Shen spirit and sudden unconsciousness.)

Regarding the manifestations of Jue in the six meridian systems:

Taiyang Jue causes head swelling, heaviness, inability to walk, dizziness, and collapse. (Taiyang Meridian starts at the inner canthus, crosses the vertex, and enters the brain, causing head symptoms. Its descending branch passes through the popliteal fossa and calf, causing walking difficulties.)

Yangming Jue causes manic epilepsy, running and shouting, abdominal fullness, inability to lie down, red and hot face, hallucinations, and delirious speech. (Yangming is the Stomach meridian, rich in Qi and Blood. Qi rebellion in the Stomach creates excess pathogens, causing mania. The meridian runs along the abdomen, causing fullness. Disharmony prevents sleep. The meridian traverses the face, causing redness and heat. Yang pathogen chaos causes mental disturbances.)

Shaoyang Jue causes sudden deafness, swollen and hot cheeks, hypochondriac pain, and knee stiffness. (Shaoyang meridian enters the ear, causing deafness. It descends to the jaw, causing cheek swelling. It passes the chest and ribs, causing pain. It exits the lateral knee, causing joint stiffness.)

Taiyin Jue causes abdominal fullness, constipation, anorexia, vomiting upon eating, and insomnia. (Taiyin meridian enters the abdomen and connects to the Spleen and Stomach. Qi rebellion in the Spleen causes constipation and digestive issues. Spleen-Stomach disharmony causes insomnia.)

Shaoyin Jue causes dry mouth, dark urine, abdominal fullness, and heart pain. (Shaoyin meridian circulates around the throat and tongue base, causing dry mouth. It connects to the Bladder, causing dark urine. Its branches connect to the Heart, causing abdominal fullness and heart pain.)

Jueyin Jue causes lower abdominal swelling and pain, abdominal distension, difficulty urinating and defecating, preference for lying down with bent knees, genital retraction and swelling, and heat in the medial thigh. (Jueyin meridian reaches the lower abdomen and stomach, causing swelling. It circles the genitals, causing urinary/reproductive issues. The Liver governs sinews; weakness causes preference for lying down. The meridian runs along the medial leg, causing heat.)

Excess patterns are treated with draining methods; deficiency patterns with tonifying methods. For neither excess nor deficiency, regulate the affected meridian.

Taiyin Jue causes calf cramping, heart pain radiating to the abdomen.

Shaoyin Jue causes false fullness, vomiting, and clear diarrhea. Jueyin Jue causes cramping, lower back pain, false fullness, urinary retention, and delirium. When all three Yin meridians rebel, causing inability to pass stool or urine and cold extremities, death occurs within three days. (Failure to pass stool or urine indicates organ failure. "Jue connecting to meridians allows life; connecting to organs causes death.")

Taiyang Jue causes rigidity, collapse, hematemesis, and frequent epistaxis. Shaoyang Jue causes joint dysfunction, inability to walk or turn the neck, intestinal abscess (incurable), and death if accompanied by fright. (Intestinal abscess in Shaoyang Jue is due to Fire-toxin accumulation. Fright indicates toxin affecting organs.) Yangming Jue causes wheezing, coughing, fever, fright, epistaxis, and hematemesis.

Hand Taiyin Jue causes false fullness, coughing, and vomiting of saliva. (Hand Taiyin meridian originates in the middle jiao, connects to the Lung.)

Hand Jueyin (Pericardium) and Hand Shaoyin (Heart) Jue cause heart pain radiating to the throat, fever, and death (incurable). (These Fire meridians govern blood vessels. Heart is the master of organs; rebellion leads to death.)

Hand Taiyang Jue causes deafness, tearing, neck stiffness, and inability to bend or extend the waist. (Hand Taiyang Small Intestine meridian connects to the ear and neck. Pathogens in the Small Intestine affect the spine and waist.)

Hand Yangming and Hand Shaoyang Jue cause sore throat, pharyngeal swelling, and spasms. (Meridians traverse the neck and throat. Spasms refer to rigidity of arms, shoulders, and neck. These are treatable based on excess/deficiency.)

Chronic headache lasting years is caused by severe cold penetrating to the bone marrow and brain, named "Jue Ni" (Reversal Jue). (Marrow belongs to the brain. Cold invading marrow causes head and tooth pain due to rebellious Qi.)

A patient with strangury (frequent small-volume urination) has deficiency. Fever like charcoal, blocked neck/chest, hyperactive Renying pulse, wheezing, and Qi rebellion indicate excess. Fine Hair-like Taiyin pulse indicates deficiency. (Strangury is frequent urination with little output. Charcoal-like heat is severe. Blocked neck/chest implies obstruction. Renying pulse reflects Yang. Taiyin pulse reflects Yin.)

The disease is in Taiyin (Spleen Yin), with excess in the Stomach (Yangming), and slightly involving the Lung. This is named "Jue," incurable death. (Yin fails to enter Yang; Yang fails to enter Yin. Both Yin and Yang are rebellious. This is "Five Excesses and Two Deficiencies." Five excesses: fever, blockage, hyperactive pulse, wheezing, Qi rebellion. Two deficiencies: strangury, fine pulse. Treating excess worsens deficiency; tonifying deficiency worsens excess. This mixed pattern is fatal.)

For Jue with right pulse deep/tight and left pulse floating/slow in winter: Right pulse matches seasons (Winter = Deep/Tight); Left pulse contradicts seasons (Floating/Slow = Rebellious). Left pulse suggests Kidney disease affecting the Lung, manifesting as lower back pain. (Kidney meridian connects to Lung. Winter Lung pulse at Kidney position indicates Kidney Qi deficiency failing to sink, causing Floating/Slow pulse. Waist is the mansion of the Kidney.)

Chest swelling, neck pain, chest fullness, and abdominal distension are also named "Jue Ni." (Yin merges with Yang, rebelling upward. Moxibustion causes aphonia; stone therapy causes madness. Treatment requires waiting for Qi harmonization.) (Moxibustion adds fire to existing upper Yang excess, damaging Yin and causing aphonia. Stone therapy drains Qi, causing emptiness and madness. Harmonizing Qi allows recovery.)