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It is stated that: When Yang Qi (Yang Energy) declines at the lower part of the body, Cold Jue (Cold Reversal Syndrome) occurs; when Yin Qi (Yin Energy) declines at the lower part, Heat Jue (Heat Reversal Syndrome) occurs. In individuals with robust constitutions, excessive depletion of Jing Essence (Essence and Qi) during autumn and winter causes the Qi below to contend upward without recovery. The overflow of Jing Essence downward allows pathogenic factors to follow and ascend, obstructing in the middle jiao. Due to the decline of Yang Qi, it cannot penetrate and nourish the meridians and collaterals. As Yang Qi diminishes day by day while Yin Qi remains alone, the hands and feet become cold; this is Cold Jue.

When Yin Qi declines at the lower part, Heat Jue occurs. This results from sexual intercourse after drunkenness or overeating, which depletes Jing Essence, causing emptiness in the middle jiao and allowing heat pathogens to enter. As Kidney Qi declines and Yang becomes excess while Yin becomes deficient, the hands and feet become hot.

When Yin Qi is excess in the upper part, the lower part becomes deficient. Lower deficiency leads to abdominal distension and fullness. Abdominal fullness causes the Qi below to become heavy and pathogenic factors to reverse. Pathogenic reversal leads to the chaos of Yang Qi. Chaos of Yang Qi causes sudden loss of consciousness, or one may remain unconscious for half a day or even a day before regaining awareness. This condition is named Shi Jue (Corpse-like Reversal Syndrome).

Note: This chapter details the manifestations of Jue syndromes in the six meridians and the reversals of the six meridians, which should be studied carefully. Generally speaking, Jue syndromes of the Yang meridians manifest as collapse, epilepsy, or hallucinations; Jue syndromes of the Yin meridians manifest as abdominal distension, difficulty in urination and defecation, vomiting, or heart pain. These are diseases caused by pre-existing phlegm-qi stagnation being attacked due to deficiency, differing only in severity.

For instance, Cheng Wuji’s commentary on the Shanghan Lun (Treatise on Cold Damage) states: "Jue" refers to cold hands and feet; "Si Ni" (Four Extremities Inversion) refers to limbs that are not warm. When pathogens are in the Three Yang meridians, the hands and feet must be hot; when transmitted to the Three Yin meridians, the hands and feet become cold. "Jue" means reversal, which differs in Yin and Yang aspects. Jue caused by extreme heat is "extreme Yang resembling Yin"; Jue caused by extreme cold is "Yin alone without Yang."

The Mai Jing (Pulse Classic) states: A pulse that beats rapidly like panting is named Qi Jue (Qi Reversal Syndrome). Patients with Qi Jue lose the ability to converse.

The Jin Gui Yao Lue Fang Lun (Essential Prescriptions of the Golden Cabinet) states: If the Cun (Inch) position of the radial pulse is deep, large, and slippery, deep indicates Excess, and slippery indicates Qi stagnation. When Excess and Qi clash, Blood and Qi enter the Zang organs. If the lips and mouth turn blue and the body becomes cold, death ensues; if the body remains warm and sweat appears spontaneously, the disease enters the Fu organs and will heal. This is called Cu Jue (Sudden Reversal Syndrome).

Note: The Fu organs are the sites of transmission and excretion, and their Qi connects freely; thus, if the disease enters the Fu organs, it heals.

Chen Wuyue states: The classics roughly divide conditions into the Six Meridians, but essentially they do not exceed two categories based on etiology: Cold and Heat. To seek comprehensive treatment, these must be clarified. Cold Jue results from excessive desire depleting Jing Essence, leading to Yang decline and Yin excess. Heat Jue results from sexual activity after drunkenness/overeating; Jing deficiency allows heat to enter, leading to Yin deficiency and Yang excess. Examining the causes of Jue, most arise from an invincible pathogen attacking its conquered element, causing Qi stagnation and resulting in reversal. For example, if Kidney transfers cold to Spleen, Water attacks Earth; since Water fails to flow, Cold Jue forms. If Heart transfers heat to Kidney, Fire attacks Water; since Fire and Water fail to interact, Heat Jue forms. This applies to all six meridians and can be discussed sequentially. Shi Jue is similar; it arises from Zang organs clashing with each other or conflicting with external pathogens, causing Qi obstruction, blockage in meridians, hiding of pulses, coma, and unconsciousness. Treatment should follow the specific Zang organ to unblock it: use heat for cold, cold for heat, and unblocking for obstruction. The classics cite frequent drunkenness as a cause of Heat Jue, but scholars should not be rigidly bound by this. Both Shanghan and Wenbing (Warm Diseases) have Heat Jue. Zhang Zhongjing’s principle "the deeper the heat, the deeper the Jue" uses alcohol’s ability to disperse heat through all meridians as an example. Cold Jue initially presents with cold limbs, deep and fine pulse without rapidity, aversion to cold, preference for covering up, diarrhea with undigested food, and patients usually remain conscious. Heat Jue initially presents with fever, headache, pulse that may be deep and hidden but is rapid upon pressure, aversion to heat, preference for cold, throwing hands and kicking feet, irritability, insomnia, constipation, and dark urine, often accompanied by stupor. Shanghan also follows this pattern.

Carefully noted: Although Cold and Heat Jue should indeed be treated according to the victory and defeat of Yin and Yang, the syndrome of Jue generally falls into the Cold and Heat categories of Shanghan. Investigating the depth of Yin-Yang reversal, other Cold-Heat Jue syndromes refer to reversal caused by accumulated cold or accumulated heat. Furthermore, Yin-Yang exhaustion and closure seen in Shi Jue and Cu Jue are not comparable to the aforementioned Cold-Heat Jue syndromes. Chen’s discussion merely scratches the surface, lacking sufficient therapeutic principles.