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There are two types of Jue (Jue syndrome, characterized by cold extremities): Yang Jue and Yin Jue. Yang Jue refers to Heat Jue, which must initially transmit from the Three Yang meridians into the Yin compartments. Therefore, at its onset, it is necessarily accompanied by headache and fever. As the pathogen moves from superficial to deep levels, it eventually affects the Three Yin meridians, transforming into cold extremities that may occasionally become warm. The symptoms invariably include constipation, restlessness, delirium, thirst, aversion to cold being absent, but rather an aversion to heat, and a deep, forceful pulse. This condition arises from the transformation of heat syndromes transmitted through the meridians. Although the exterior presents with cold extremities, the interior is caused by heat pathogens. Since this is a Yang syndrome manifesting as Jue, it is termed Yang Jue, representing "extreme Yang resembling Yin." This syndrome results from internal accumulation of evil heat or the failure to purge latent Yang heat. When Jue is mild, the heat is also mild, and formulas similar to Sini San (Four Counterflow Powder) are appropriate; when Jue is severe, the heat is also severe, and formulas similar to Chengqi Tang (Descending the Qi Decoction) are appropriate.

Yin Jue refers to Cold Jue. Initially, there are no excess heat syndromes characteristic of transmission through the Three Yang meridians; instead, true cold directly invades the Three Yin meridians. Symptoms include fear of cold, cold extremities, abdominal pain, vomiting, diarrhea, shivering, absence of thirst, and a deep, weak pulse. This is Yin-cold Jue-ni (rebellious counterflow), characterized by exclusive Yin without Yang, hence termed Yin Jue. Mild cases are treated with Lizhong Tang (Regulate the Middle Decoction), while severe cases are managed with Sini Tang (Reverse the Five Extremities Decoction) or Hu yang (Restore Yang) decoctions.

Cheng Wuji stated: "Sini" refers to limbs that are not warm. When Shaoyang disease pathogens are in the Three Yang meridians, the hands and feet are necessarily hot; upon transmission to Taiyin, the hands and feet naturally become warm; reaching Shaoyin, the pathogenic heat deepens, causing the limbs to be cold and not warm; upon reaching Jueyin, the hands and feet become completely cold, which is more severe than "Ni," thus Sini San is used to dissipate the heat syndrome transmitted into the Yin.

The Classic states: "For all cases of Sini and Jue, purgation should not be used; this applies equally to those with deficiency constitutions." Cheng Wuji annotated: "Sini" refers to limbs that are not warm; "Jue" refers to cold hands and feet, which is more severe than Sini. Both result from scant Yang qi and abundant Yin qi, so purgation is contraindicated; this applies equally to those with deficiency constitutions. The *Jinkui Yuhan* states: "For deficiency, tonify ten times; do not purge even once."

The Classic states: "All Jue syndromes occur when Yin and Yang qi fail to connect smoothly, resulting in Jue. Jue is characterized by cold extremities. If a patient has cold extremities and states they do not have a Jie Xiong (Chest Binding) syndrome, but have fullness and tenderness upon pressure in the lower abdomen, this indicates cold binding at the Bladder's Guanyuan acupoint. In Shaoyang disease, if there is fever for four days, followed by three days of Jue, then fever for another four days, with less Jue and more heat, the disease should resolve. In Shaoyang disease, if there is Jue for four days, followed by three days of heat, then Jue for five days, the disease progresses. More cold and less heat indicate the退 (retreat) of Yang qi, hence the progression. If Jue is accompanied by vomiting and chest/hypochondriac fullness and irritability, hematochezia (blood in stool) will likely follow later."

The Classic states: "In Shaoyin disease, with dysentery passing undigested food, interior cold with exterior heat, cold extremities, and a faint pulse nearly imperceptible, yet the body feels no aversion to cold, and the person has a red complexion, or abdominal pain, dry retching, sore throat, or cessation of dysentery with non-palpable pulse, Tongmai Sini Tang (Pulse-Restoring Sini Decoction) is indicated. In Shaoyang disease with a rapid pulse and cold extremities, moxibustion may be applied. In Shaoyang disease with a slippery pulse and Jue, there is interior heat, treated with Baihu Tang (White Tiger Decoction). For cold hands and feet with a fine pulse nearly absent, Danggui Sini Tang (Angelica Sinensis Decoction to Restore the Five Extremities) is indicated. If the patient has chronic interior cold, Danggui Sini Tang plus Wuzhuyu and Shengjiang (Evodia and Fresh Ginger) is appropriate. For profuse sweating with persistent heat, interior tension, limb pain, accompanied by dysentery, Jue, and aversion to cold, Sini Tang is indicated. For profuse sweating or severe dysentery leading to Jue, Sini Tang is indicated. For patients with cold extremities and a suddenly tight pulse, the pathogen is bound in the chest, causing central fullness and irritability, hunger but inability to eat; the disease is in the chest and requires emesis, using Gouti San (Melon Seed Powder). In Shaoyang disease with Jue and epigastric palpitations, water retention should be treated first with Fuling Gancao Jiang Tang (Poria, Licorice, and Ginger Decoction), then treat the Jue. Otherwise, water will infiltrate the stomach, causing dysentery. For dysentery passing undigested food, interior cold with exterior heat, sweating, and Jue, Tongmai Sini Tang is indicated. For vomiting with a weak pulse, frequent urination, slight body heat, and appearance of Jue, the prognosis is difficult; Sini Tang is indicated."

Commentary: The differentiation between Yang Jue and Yin Jue was described above, which is the great method of the sages. However, I still have further distinctions. Regarding Yin Jue, since there are no Yang symptoms or Yang pulses, and the pathology is clearly cold, it is undoubtedly a Yin syndrome. Nowadays, people simply call it Zhong Han (Cold Strike), which is the disease itself. Few suffer from this, and recognizing it is not difficult; treatment should focus on warming the middle, requiring no further differentiation. Only Yang Jue requires necessary differentiation. Jue transmitted from the Three Yang meridians is called Yang Jue, which is correct. But even considering transmission, are there not Yin syndromes? Thus, anyone with true Yang insufficiency suffers from Yang-within-Yin Jue; those with weak, spiritless pulses suffer from Yang-within-Yin Jue; those over-treated with attacking and cooling methods suffer from Yang-within-Yin Jue. The four limbs are the root of all Yang qi. Unless there are symptoms such as heat binding, irritability/thirst, and distension/fullness/excess, Jue appearing in their absence is due to Yang qi insufficiency. Cheng Wuji said: "Generally, Jue-ni is governed by Yin and is mostly cold." He also said: "Jue represents the flourishing of Yin." Therefore, for all cases of Cold Damage complicated by deficiency, even if transmitted from Yang meridians, it is Yang-within-Yin Jue. If Yin-within-Yin requires warming, does Yang-within-Yue truly require cooling? Students should not assume that because there was initial headache and fever, and it came from the Three Yang meridians, it is Yang Jue, and thus apply cold-for-heat usage, which would cause significant harm.

1. Zang Jue (Organ Jue) Syndrome. Zhang Zhongjing said: "In Cold Damage, with a faint pulse and Jue, after seven or eight days, the skin becomes cold, and the person is restless with no moment of peace; this is Zang Jue. Zang Jue is a death syndrome, indicating the extinction of Yang qi."

2. Hui Jue (Roundworm Jue) Syndrome. Zhang Zhongjing said: "In Hui Jue, the patient should vomit roundworms. Now, the patient is quiet but periodically irritable; this is due to cold in the Zang, causing roundworms to ascend into the Diaphragm, hence the irritability. After a short while, it stops again. Upon eating, vomiting occurs, and irritability returns because the roundworms emerge smelling the food odor; the patient should spontaneously vomit roundworms. Hui Jue is treated with Wumei Wan (Mume Pill)." Cheng Wuji said: "Zang Jue is a death syndrome, indicating the extinction of Yang qi. Although Hui Jue involves Jue and irritability, it becomes quiet after vomiting roundworms, unlike Zang Jue where there is constant restlessness. Because the patient has cold in the Zang and deficiency in the Stomach, Wumei Wan should be given to warm the Zang and pacify the parasites."