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The *Classic of Difficult Issues* (Jing Yun) states: In the disease of Jue (Reversal), the feet suddenly become cold, the chest feels as if it is splitting, the intestines feel as if cut by a knife, there is irritability and an inability to eat, and the pulse is choppy regardless of its size. This occurs when cold pathogens invade the five Zang organs, causing rebellious Qi to ascend and dissipate, leading to the exhaustion of Yin Qi and the failure of Yang Qi to enter. Consequently, there is sudden severe pain, death-like coma, and loss of consciousness. If Qi returns to normal circulation, the patient will survive.

According to the *Treatise on Jue* in the *Suwen*: What causes the cold and heat manifestations in Jue? When Yang Qi is deficient in the lower part of the body, Cold Jue occurs; when Yin Qi is deficient in the lower part, Heat Jue occurs. "Yang Jue" arises from frequent anger. "Feng Jue" (Wind Jue) presents with spasms of the hands and feet, sweating, and persistent irritability and fullness. "Wei Jue" (Flaccidity Jue) is a combination of Wei syndrome (flaccidity) and Jue, characterized by weak and powerless legs. "Bi Jue" (Obstruction Jue) combines Bi syndrome (obstruction/painful obstruction) with Jue, presenting as numbness, swelling, and pain in the legs (Hong Kong foot/gouty arthritis); what the world calls "Hong Kong foot rushing to the heart" belongs to this category. "Jue Bi" refers to getting up from bed and being exposed to wind, causing blood to coagulate in the skin (forming Bi), stagnate in the vessels (causing sluggish flow), or coagulate in the feet (causing Jue). Modern people also refer to sudden fainting, loss of consciousness, and cold hands and feet as Jue. Zhang Zhongjing, in his discussion of Shanghan (Cold Damage), classifies cases where Yang syndrome transmits to Yin channels, resulting in cold hands and feet, as Heat Jue, treating them with Sini San (Four Reversal Powder). Cases of Yin syndrome with aversion to cold and cold hands and feet are classified as Cold Jue, treated with Sini Tang (Four Reversal Decoction). However, the meaning in the *Neijing's Treatise on Jue* is different. The three Yang meridians of the foot originate from the lateral side of the toes, and the three Yin meridians originate from the medial side. Therefore, excess Yang leads to heat in the soles, while excess Yin leads to cold from the toes up to the knees. This cold does not come from outside but originates internally. The cause of Cold Jue is described as a deficiency of Yang Qi, which fails to moisten and nourish the collaterals. As Yang Qi diminishes daily, only Yin Qi remains, causing coldness in the hands and feet; Fuzi Lizhong Tang (Aconite and Ginger Decoction for Regulating the Middle) is indicated. The cause of Heat Jue is described as occurring after excessive drinking or intercourse after a full meal, where Qi accumulates in the spleen. Kidney Qi declines daily, leaving Yang Qi in excess, causing heat in the hands and feet; Jiajian Bawei Wan (Modified Eight-Ingredient Pill) is indicated.

The *Classic* states: When the body's Yang Qi is subjected to excessive mental and physical labor, it becomes hyperactive, leading to the depletion of essence. ("Zhang" means hyperactivity/excess. Excessive labor leads to essence depletion.) If this condition accumulates during summer, it causes Jian Jue (Boiling Jue). (Summer heat injures Qi, causing Qi rebellion and Jian Jue.) Symptoms include blindness and deafness. Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) is indicated. It also states: When Yang Qi is subjected to extreme anger, the form and Qi become severed, and blood stagnates in the upper body, causing Bo Jue (Thin/Forceful Jue). (Blood accumulates in the chest without dispersing, obstructing the airway and causing violent rebellion). Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is indicated. When the Yangming and Shaoyin meridians are affected together, it is named Feng Jue. (Liver Wood overacts on Stomach Earth, Wind overcomes Dampness, and fails to control Kidney Water, causing upward rebellion). Dihuang Yinzi (Rehmannia Infusion) is indicated. Additionally, bone pain and withered nails constitute Bone Jue; finger spasms preventing flexion and extension constitute Arm Jue; standing rigidly like a rafter constitutes Liver Jue. All these result from internal deficiency and Qi rebellion and are suitable for Bawei Wan (Eight-Ingredient Pill). Panting, mania, running, and climbing high indicate Yangming Jue, which is an excess pathogen pattern, treated with Chengqi Tang (Order the Qi Decoction) to purge. Jue accompanied by abdominal fullness and unconsciousness, or sudden confusion, results from pathogenic disturbance and rebellious Yang Qi, indicating that the Shaoyin Kidney pulse is absent. This is named Shi Jue (Corpse Jue), caused by sudden exposure to malignant Qi of heaven and earth. Emergency treatment involves Erqi Dan (Two-Qi Pill), 2 qian, decocted in aged wine. When ammonium nitrate crystals appear to rise, pour into a basin, cover, and take warm. After walking about five li, administer another dose. Within three doses, the patient should awaken. For patients with underlying deficiency due to rich diet, use one piece of Fuzi (Aconite Root) and 3 liang of Renshen (Ginseng Root), decocted in wine, divided into three doses. Also moxa Baihui (GV20) with 49 moxa cones and Qihai (CV6)/Dantian with 300 moxa cones. Stop moxibustion when the body warms. Moxa cones should be no larger than mung beans; larger ones will damage the tissue. For sudden Jue with hidden pulse and unconsciousness, where Yin and Yang cannot be distinguished, emergency treatment uses three eggs. Boil them, peel while hot, make a bean-sized hole, place a layer of coarse paper over the navel aligned with the hole, allowing heat to penetrate until the patient revives. Then treat according to pulse and symptoms. If three eggs fail to work, the case is incurable.

Zhang Jiebin stated: Jue originating in the feet marks the onset of the attack. It may progress to sudden collapse and violent Jue, with immediate loss of consciousness. Mild cases recover gradually; severe cases lead to immediate death. It is a critical emergency. Later physicians failed to examine it carefully, defining Jue merely by cold or hot hands and feet, or even confusing it with Hong Kong foot (gouty arthritis), which is a significant error. Although Zhang Zhongjing distinguished Cold and Heat Jue based on hands and feet, he was specifically distinguishing cold and heat in Shanghan, not referring to the Jue of the *Neijing*. The *Daqi Lun* states: In violent Jue, the patient cannot speak. The *Tiaojing Lun* states: When blood and Qi rush upward together, it causes Great Jue, leading to sudden death; if Qi returns downward, the patient lives; if not, they die. The *Miaoci Lun* states: When the five collaterals of the hand-foot Shaoyin, Taiyin, and Yangming are exhausted, the body becomes heavy and insensible, resembling a corpse, known as Shi Jue. Such conditions are certainly not limited to cold/hot extremities or gout. Today, most people do not understand Jue and mistake it for Zhongfeng (Wind Stroke). Zhongfeng usually involves injury to the meridians, whereas Jue is directly caused by the internal depletion of essence and Qi. Exterior/interior and deficiency/excess must be differentiated. Misnaming the condition explains why wind treatments are wrongly applied to Jue. No harm in medicine is greater than this.

[Diagnosis] A deep, faint, non-rapid pulse indicates Cold Jue; a deep, hidden, rapid pulse indicates Heat Jue; a deep, fine pulse indicates Qi Jue; a knotted, large pulse indicates Blood deficiency; a floating, slippery pulse indicates Phlegm; a wiry, rapid pulse indicates Heat; a floating pulse indicates external contraction. A pulse coming rapidly like panting is named Bao Jue (Violent Jue). A cun pulse that is deep and slippery: deep indicates Qi stagnation, slippery indicates Excess. When Excess and Qi contend, blood and Qi enter the Zang organs. If lips, mouth, and body become cold, it is fatal. If the body is warm and sweating spontaneously, the pathogen has entered the Fu organs; this is Cu Jue (Sudden Jue).

Sun Zhao treated a patient who sweated spontaneously, had cold feet extending below the knees, abdominal pain, and unconsciousness. The six pulses were small, weak, and rapid. Upon asking about previous medications, all were Yang-tonifying drugs. Sun Zhao concluded that the illness was not severe, but the medication aggravated it. He prescribed Wuling San (Five-Ingredient Powder with Poria) and Baihu Tang (White Tiger Decoction) for over ten doses, resulting in recovery. In Yin Jue, if the calves are cold, the arms are also cold. Here, the calves were cold but the arms were not, indicating it was not Lower Jue ascending, thus confirming it as Yang Jue.

Wang Shishan treated a patient with sudden Jue, appearing dead and unconscious. Previously, the patient had slight chills and recurrent fevers, with a sallow complexion. The six pulses were deep, wiry, and fine. Wang diagnosed long-term depression of Middle Qi. He administered Ren Shen Qi Qi Tang (Ginseng Seven-Qi Decoction). Before the medicine was ready, the patient suddenly ceased breathing. Wang ordered someone to hold the patient tightly, breathed into their mouth to transfer Qi, and slowly poured hot ginger soup down their throat. He prohibited noise and movement, stating that movement would prevent Qi from returning. Shortly after, the patient revived. After half a month of warming and nourishing care, the patient recovered. This applies not only to this case but to all instances of Zhongfeng, Zhong Qi, Zhong Shu (Heatstroke), Zhong Han (Cold Strike), and Bao Jue. One must not disturb the patient, as this severs the Qi. The *Neijing* clearly states that if Qi returns, life is preserved. Those who do not understand this and disturb the Qi, preventing its return, cause many premature deaths.