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Jue (Reversal Cold) refers to reversal and disarray, specifically manifesting as cold extremities. The clinical manifestations vary, and there are many descriptions scattered across medical texts. Here, we summarize the general principles. Cold-heat Jue reversal is discussed under the Wind-Cold syndrome in the Injury section.

Shi Jue (Corpse Jue), also known as Fei Shi (Flying Corpse), Cu Jue (Sudden Jue), or Zhong E (Smitten by Evil) in this section.

Hui Jue (Roundworm Jue) is discussed under the Vomiting of Roundworms syndrome in the Vomiting section.

Tan Jue (Phlegm Jue) and Yin Jue (Fluid Retention Jue) are discussed under various syndromes in the Vomiting section.

Qi Jue (Qi Stagnation Jue), also known as Zhong Qi (Strike of Qi), is discussed under the Zhong Qi syndrome in this section.

(Attachment on Common Cold: When treating patients, do not use realgar powder applied to the nostrils. One must know to avoid entering from the side where travelers sit. For male patients, foul qi emanates from the mouth; for female patients, it emanates from the yin region. When sitting, standing, or conversing face-to-face, one should be aware of the orientation.)

Wind Injury (Shang Feng) and Cold Injury (Shang Han) are commonly referred to as Shang Han. The transmission of disease through meridians is divided into Three Yang and Three Yin. The Three Yang are the Taiyang (Greater Yang), Yangming (Yang Brightness), and Shaoyang (Lesser Yang) meridians. The Three Yin are the Taiyin (Greater Yin), Shaoyin (Lesser Yin), and Jueyin (Terminal Yin) meridians. The yin-yang of meridians is defined by zang-fu organs. Fu organs are yang: Bladder, Stomach, and Gallbladder. Zang organs are yin: Spleen, Kidney, and Liver. The yin-yang of diseases refers to the yin-yang of external pathogens, namely Yin Qi and Yang Qi. Both can invade the zang-fu. If Yang Qi invades Taiyang, it results in Wind Injury, characterized by aversion to wind and sweating. If Yin Qi invades Taiyang, it results in Cold Injury, characterized by aversion to cold and absence of sweating. If the condition at Taiyang is not resolved, it may transmit to the Yangming and Shaoyang meridians, becoming purely yang, which is easier to treat than Taiyang. If yang pathogen persists and transmits sequentially to the yin meridians, it becomes "Yang within Yin." Although symptoms such as spontaneous diarrhea, desire to sleep, blue lips, cold extremities, curled tongue, and retracted scrotum may appear, hot herbs should not be recklessly administered. Instead, one should purge the yang pathogen residing in the yin meridians.

If yang disease is treated with purgatives excessively, yang qi may collapse and transform into yin. This is described as "the harm of heat has not ceased, yet cold disease arises again." Or, if yin manifests from the onset, it is "Yin within Yin," caused by yin pathogen attacking yin meridians directly, rather than transmitting from yang meridians. In such cases, warm herbs should be used to restore yang. Thus, when yang enters yin, yang is transformed to save yin; when yin enters yang, yang is used to save yang. These two scenarios must be distinguished.

At the onset of Wind Injury or Cold Injury, fever, headache, and body pain are common, belonging to the Taiyang meridian. However, Wind Injury presents with aversion to wind and sweating, while Cold Injury presents with aversion to cold and no sweating. Both may initially be treated with Hejie San, Xiong Zhi Xiang Su San, or Yangwei Tang added with Ban Qian of Chuanxiong and Fangfeng, taken hot with warm covering to induce sweat. If it is indeed Wind Injury with spontaneous sweating and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) should be used, taken hot with warm covering. For wheezing, add 1 qian of Xingren (Apricot Seed); for cough, add 1 qian of Wuweizi (Schisandra Berry); for thirst, add 0.5 qian of Renshen (Ginseng). If external heat persists, Baidu San (Detoxification Powder) is indicated. If there is heat with sweating, Baidu San added with 0.5 qian of Guizhi (Cinnamon Twig) or Yangdan Tang is suitable. For vomiting, Guizhi Tang is contraindicated; instead, add 1 qian of Banxia (Pinellia Tuber) and ginger to the base formula. This vomiting is not due to combined disease but is a mixed condition of cold injury, so it is permissible. For Wind-Cold conditions, sweating therapy is appropriate, but if the patient is deficient and cannot tolerate sweating, Guizhi Tang added with 0.5 qian of Huangqi (Astragalus Root) is recommended. If it is indeed Cold Injury with aversion to cold and no sweating, Wuji San (Five Accumulations Powder) should be taken hot with thick blankets to induce sweating. For wheezing and cough, Xingzi Tang added with 0.5 qian of Mahuang (Ephedra Herb) is used. If sweating is desired but not achieved, administer again. If fever persists after sweating, Shensu Yin or Baidu San added with 0.5 qian of Guizhi is indicated. For vomiting, Yangwei Tang is used. This is not for combined disease vomiting. If both wind and cold injure, or if there is aversion to wind without sweating or aversion to cold without sweating, creating diagnostic uncertainty, half a dose of Wuji San mixed with half a dose of Baidu San, named Jiaojia San (Intersecting Addition Powder), is appropriate. For wheezing and cough, Xiao Qinglong Tang (Minor Green Dragon Decoction) is used. If Taiyang symptoms are present at onset but only cold without immediate heat, developing heat after one or two days, it is Cold Injury. Wind Injury would have heat immediately. If only cold without heat, Wuji San is used to induce sweating. If exterior-releasing drugs have been taken, and there is no aversion to wind or cold, and all exterior symptoms have resolved, yet internal signs show no restlessness or thirst, urine is normal, stool is normal, but fever persists, Xiangsu Yin, Baidu San, or Xiao Chaihu Tang (Minor Bupleurum Decoction) added with 0.5 qian of Guizhi is indicated. If exterior symptoms have resolved after taking exterior-releasing drugs, and there are no interior symptoms, but body pain persists, it may be due to excessive sweating causing disharmony of Ying and Wei nutrients. Xiaojianzhong Tang (Minor Construct the Middle Decoction) using cinnamon bark of medium strength is suitable.

If Wind-Cold conditions transmit through meridians, presenting with fever, irritability, thirst, red urine, constipation, inability to speak, restless sleep, dry nose, head and eye pain, worsening in the afternoon (Dibang), aversion to heat rather than cold, white coating on the tongue with cracks, or black coating indicating extreme heat, even coma, this belongs to the Yangming meridian. Daxiehu Tang (Major Bupleurum Decoction) or Xiaochengqi Tang (Minor Cabbage Decoction) should be used to purge. If these symptoms are present but bowel movements are normal, Baihu Tang (White Tiger Decoction) with a small amount of Xiao Chaihu Tang is indicated. If chest and hypochondrium are painful, headache, deafness, bitter taste in mouth, thirst or vomiting, irregular bowel movements, and alternating chills and fever resembling malaria occur, this belongs to Shaoyang syndrome. Xiao Chaihu Tang is indicated. Add 0.5 qian of Bei Wuweizi (North Schisandra) for cough, 0.5 qian of Gualougen (Trichosanthes Root) for severe thirst, 0.5 qian of Guizhi for external heat without thirst. For spontaneous sweating with lingering aversion to wind, mix half a dose of Xiao Chaihu Tang with half a dose of Guizhi Tang.

In women's diseases, if menstruation occurs suddenly or stops abruptly during illness, this is Heat Entering the Blood Chamber. The blood will clot, causing alternating chills and fever like malaria, clarity during the day, and delirium at night. Xiao Chaihu Tang is indicated, or add 0.5 qian of Sheng Dihuang (Fresh Rehmannia Root).

If chest and diaphragm feel uncomfortable, hands and feet are naturally warm, or there is spontaneous diarrhea with thirst, or abdominal fullness and occasional pain, this belongs to the Taiyin meridian. If spontaneous diarrhea without thirst, Lizhong Tang (Regulate the Middle Decoction) in heavy dosage is used, or Fuzi Si Ni Tang (Aconite Reversal Cold Decoction) if severe. This is Yin within Yin. For abdominal fullness and pain requiring unblocking, Guizhi Tang added with Shaoyao (Peony Root), which is Xiaojianzhong Tang, but using Guizhi (Cinnamon Twig) instead of thick cinnamon bark. If ineffective, Xiao Chaihu Tang without Huangqin (Scutellaria Root) plus 1 qian of Shaoyao, or 0.5 qian each of Zhishi (Immature Bitter Orange) and Shaoyao. For severe abdominal pain with constipation, Guizhi Tang added with 1 qian of Dahuang (Rhubarb Root) added near the end of decoction, or Daxiehu Tang. Purge based on excess pain; this is Yang within Yin.

If there is persistent nausea, heart vexation, preference for sleep, or spontaneous diarrhea with dry mouth and thirst, or neutral mouth temperature with aversion to cold on the back, this belongs to the Shaoyin meridian. Medication for Shaoyin differs by yin-yang. For spontaneous diarrhea with thirst, Zhu Ling Tang (Polyporus Decoction) is indicated because heat transmitted to the Kidney affects the tongue root. Zhu Ling Tang drains heat from the Kidney. If ineffective, purge via stool. Ancient methods combine Dachengqi Tang (Major Cabbage Decoction). If Dachengqi Tang is difficult to use, Xiaochengqi Tang or Baitouweng Tang (Pulsatilla Decoction) may be advanced. These drugs represent extreme Yang within Yin.

For dysentery with heaviness and cold extremities, first decoct Ban Ban Shui (half cup water) with two roots of Congbai (Green Onion White) to one cup, remove onions, then decoct Sini San (Reversal Cold Powder) to 70%. Add 0.5 qian each of Bei Wuweizi and Ganjiang (Dried Ginger) for cough, 1 qian of Guizhi for palpitations, 1 qian of Fuling (Poria) for difficult urination, 0.5 qian of Shu Fuzi (Prepared Aconite) for abdominal pain.

If confirmed as diarrhea with undigested food, cold extremities, flushed face, or abdominal pain, dry retching, or sore throat, Si Ni Tang with doubled Ganjiang is used. For flushed face, add one root of Congbai. For abdominal pain, add 1.5 qian of Shaoyao. For vomiting, add Shengjiang (Fresh Ginger). For throat issues, add Jiegeng (Platycodon Root) 1 qian.

If the mouth feels neutral with aversion to cold on the back, Zhengfang Si Ni Tang (Standard Formula Si Ni Decoction) without modifications is used. Both Sini San and Si Ni Tang treat Shaoyin diarrhea and cold extremities. Dysentery with heaviness versus diarrhea with undigested food represents one cool and one warm, distinguishing yin and yang. (Sini San treats Yang syndrome of reversal cold; Si Ni Tang treats Yin syndrome of reversal cold.)

If Shaoyin symptoms appear at onset with fever, aversion to cold, body pain but no headache, Mahuang Xixin Fuzi Tang (Ephedra, Asarum, and Aconite Decoction) is used to induce slight sweating. Alternatively, Wuji San added with 0.5 qian of Shu Fuzi, or Wuji San combined with Yishun Yuan San. For irritability, reversal cold, curled tongue, retracted scrotum, or diarrhea with undigested food, interior cold with exterior heat, this belongs to Jueyin meridian. Diarrhea with undigested food is Yin within Yin; Tongmai Si Ni Tang (Pulse-Recovering Si Ni Decoction) or Danggui Sini Tang (Angelica Reversal Cold Decoction) added with Shengjiang and Zhuyu (Cornus Fruit) is indicated. Curled tongue and retracted scrotum are not only seen in Yin within Yin but also when Yangming heat sinks into Jueyin. Yangming governs the sinews, which are affected by heat toxin and wind, leading to contraction pulling the tongue and genitals. Purge yang to save yin with Dachengqi Tang. When Yang transmits to Taiyin causing diarrhea, Xiaojianzhong Tang and Xiao Chaihu Tang without Huangqin plus Shaoyao are used. This treats Taiyin diarrhea with intestinal murmurs and pain. Pain after diarrhea indicates deficiency causing murmurs due to declining yang qi transmitting to yin. Avoid excessive cold agents; use Shaoyao to unblock.

Nanyang stated that Shang Han always causes slightly cold extremities, and naturally warm extremities indicate Taiyin. This explanation is unclear. How could Yangming extremities be slightly cold? Shaoyang and Jueyin are very cold, not slightly cold. It should be said that among the Three Yin meridians, Shaoyin and Jueyin have cold extremities, while only Taiyin has naturally warm extremities.

For thirst, ask about drinking preferences: cold or hot, much or little. Drinking much and desiring cold indicates Yang thirst. Further examine which meridian syndrome is present. For Taiyang syndrome with difficult urination and thirst, Wuling San (Five-Ling Powder) is used. For Yangming syndrome with constipation and thirst, seek treatment in the respective meridian. If diarrhea persists with thirst, Baihu Tang is indicated. For Shaoyang syndrome with alternating chills/fever and thirst, Xiao Chaihu Tang without Banxia plus equal amount of Gualougen is used. Yin syndromes may also have spontaneous diarrhea with thirst, as seen in their respective meridions. Ancient practitioners often used cold agents for yin thirst because they involve residual yang qi. Although the meridian is yin, the pathology is yang. However, some cases of diarrhea with undigested food are pure yin syndromes yet present with thirst. This is yin below blocking yang above, compounded by fluid loss from diarrhea causing dryness. Patients drink little and prefer warmth; do not use cold agents. Lizhong Tang or Si Ni Tang added with 1 qian of Renshen is suitable. For severe thirst, Lianli Tang is used.

There are yang syndromes without thirst and yin syndromes with reverse thirst. Yangming thirst is mild; Taiyin thirst is severe. Treatment for thirst varies. Strengthening kidney water stops thirst (using Tianhuafen/Fritillaria Thunbergii Rhizome); promoting urination cures thirst (using Fuling/Poria and Zhuling/Menodora Root). For Taiyin, promoting urination is priority; for Yangming, it is cautioned against. Shaoyang involves the Gallbladder meridian, half-exterior/half-interior, not suitable for purging. For severe unrelenting thirst, Xiao Chaihu Tang added with Tianhuafen strengthens kidney water. Once kidney water is strengthened, it渗 into the Large Intestine, slightly moistening stool, clearing heat and resolving thirst. For Taiyang disease involving Bladder/Kidney meridians, unless urination is promoted, heat cannot leave, and thirst cannot resolve. Additionally, non-yang syndromes with vexation and thirst are caused by yin excess blocking yang; do not follow thirst, treat yin instead.

Vexation occurs in both yin and yang meridians. Yangming stomach heat/feces causes vexation, requiring purging. Taiyang vexation after sweating uses Wuling San. Shaoyang may also have vexation, treated with Xiao Chaihu Tang. Yin vexation is mostly Shaoyin, caused by yang qi transmitting to yin, where yin receives yang and becomes vexed. Spontaneous diarrhea with thirst, vexation, and insomnia use Chen Sha Wuling San (Cinnabar Five-Ling Powder). If not yang transmitting to yin, but yin attacking yin meridians with vomiting, diarrhea, cold extremities, and vexation, classics state: "Yang deficiency allows yin invasion causing vexation" and "Yin excess causes agitation, wanting to sit in a well." Use Wuzhuyu Tang. Severe cases use Si Ni Tang added with two roots of Congbai.

Additionally, deficiency vexation occurs after recovery when yin-yang are not restored, causing intermittent heat/vexation. Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is used. For phlegm with restless sleep, Wendan Tang (Warm Gallbladder Decoction) is used. For vomiting, Jupi Tang (Tangerine Peel Decoction). See Cold-Heat Section for tidal fever and deficiency vexation. If mistakenly purged, leading to persistent fever and mild vexation, Zhizi Jiangye Tang (Gardenia and Ginger Decoction) is used.

Diarrhea must distinguish yin/yang. Three Yang diarrheas are seen in their respective meridians. Taiyin-Yangming combined disease with diarrhea, headache, back pain, muscle heat, eye pain, dry nose uses Gegen Tang (Kudzu Decoction). Yangming-Shaoyang combined disease with diarrhea, fever, chest/hypochondriac fullness, vomiting, alternating chills/fever, eye pain, dry nose uses Daxiehu Tang. Generally, yang-heat diarrhea differs from yin-heat and yin-cold diarrhea. Yang diarrhea features dark yellow, hot, foul-smelling stool, sound emission, warm umbilicus, stopping with cold meds, worsening with hot meds. Yin diarrhea features clear undigested food, white/pale yellow stool, cold umbilicus, treated with warming/astringent agents. This refers to yin/yang qi, not meridians. Yin may contain yang diarrhea; do not assume all diarrhea is yin.

If Taiyang syndrome is mistakenly purged, leading to diarrhea with undigested food and body pain, urgently use Si Ni Tang to rescue the interior. After stool normalizes, if body pain persists, use Guizhi Tang to release the exterior. (Rescue interior first to prevent collapse from severe diarrhea.)

If interior is not fully full but chills/fever persist, and purging is premature, interior deficiency allows heat entry, causing heat-associated diarrhea with warm umbilicus, reddish-yellow stool, and greasy intestinal fluid, named Li Chang (Intestinal Diarrhea). Use Baitouweng Tang or Huangqin Tang.

Note that all are diarrhea: naturally warm extremities without fever indicate Taiyin; cold extremities indicate Shaoyin/Jueyin. Remaining fever with diarrhea belong to yang meridians. However, yin diarrhea may have reverse fever, or no fever initially followed by fever after diarrhea, or initial fever followed by diarrhea. This is yin diarrhea, not yang transmitting to yin. See Fever Section.

Constipation for 5-6 days treated with laxatives leading to unceasing diarrhea requires extremely hot agents to cure. Yang has diarrhea and constipation; distinguish by other symptoms.

Exterior heat, interior vexation, diarrhea, upper thirst, or bloating/pain/vomiting usually use Huangqin Tang or Banxia Xiexin Tang, but Shengjiang Xiexin Tang (Fresh Ginger Pinellia Heart-Middle Dissipating Decoction) is more appropriate. Or Wendan Tang added with Huanglian (Coptis Rhizome); usage of Zhike (Bitter Orange) depends on judgment.

All yang fevers are seen in the first three yang meridians. Yin does not typically fever, except Shaoyin. Shaoyin fever has two types: onset with Shaoyin symptoms, fever, aversion to cold, no headache uses Mahuang Xixin Fuzi Tang. (Shaoyin disease starting with reverse fever is mostly exterior; use this decoction.) If diarrhea with undigested food, fever, restlessness, interior cold/exterior heat, Zhang Zhongjing calls it "reverse fever," caused by yin excess blocking yang. Use Si Ni Tang or Fuzi Lizhong Tang. Yang transmitting to yin causes heat diarrhea (yang sinking inside, no exterior heat). Yin entering yin causes interior cold diarrhea (cold dominant inside, yang guest outside, hence exterior heat). Differentiate: yang fever has headache; yin fever has no headache.

After sweating/purging, chills/fever recur. Only aversion to cold after sweating indicates deficiency (exterior deficiency). Only heat after sweating indicates excess (interior excess). Only aversion to cold implies excessive sweating depleting yang ("Yang micro leads to aversion to cold"); use Shaoyao Gancao Fuzi Tang. Only fever implies exterior resolved but interior unresolved ("Yin micro leads to fever"); use Daxiehu Tang or Xiaochengqi Tang.

After sweating/purging, if yin-yang do not interact, water-fire do not harmonize, leaving residual heat, do not use cold meds. Neither interior nor exterior can be attacked; use Xiaojianzhong Tang. If already deficient generating heat, use Xiaojianzhong Tang added with 1 qian of Danggui (Angelica Sinensis Root), or Sijunzi Tang (Four Gentlemen Decoction) added with 0.5 qian of Huangqi, or Shiquan Dabu Tang (Ten Complete Tonifying Decoction) to regulate Ying/Wei. For deficiency, Sigui Tang or Zhenwu Tang. If evil heat remains despite sweating/purging, do not fear tonics; use Zhuye Shigao Tang.

Tidal fever: Classics state "Tidal fever is Stomach excess," belonging to Yangming, requiring purging. This tidal fever is isolated heat occurring mostly at Dibang (afternoon), like tides, not alternating chills/fever.

After recovery, overeating causing fever is Food Recurrence (Shi Fu). Overexertion causing fever is Labor Recurrence (Lao Fu). Recurrence means healing then relapsing. Food recurrence uses Xiao Chaihu Tang added with 1 qian of Dahuang. Labor recurrence uses Zhishi Zhizi Tang (Immature Bitter Orange and Gardenia Decoction) or Xiao Chaihu Tang. Modern warnings about bathing/cleaning clothes/hair/bed to avoid ghosts are actually concerns about impurity and excessive labor causing recurrence.

Vomiting has cold/heat types. No substance vomited is Ou (retching); with substance is Tu (vomiting). Ancients spoke of Gan Ou (dry retching) but not Gan Tu. Taiyang-Yangming combined disease with fever, headache, stiff neck, vexation, dry nose, eye pain, vomiting uses Gegen Tang added with 1 qian of Banxia. Taiyang-Shaoyang combined disease with headache, back pain, alternating chills/fever, chest/hypochondriac pain, vomiting uses Huangqin Tang added with 1.5 qian of Banxia and five slices of Shengjiang. If Shaoyang symptoms are not combined disease, vomiting with heat uses Xiao Chaihu Tang. If Yangming symptoms are clear with purging indication, but frequent vomiting suggests upper jiao involvement, do not purge quickly; use Xiao Chaihu Tang. If Taiyang is not combined with Shaoyang/Yangming, but shows Taiyang symptoms with vomiting/diarrhea, suspect phlegm-fluid retention in diaphragm; stabilize with Erchen Tang (Two-Aged Decoction). After vomiting settles, slowly administer Taiyang releasing meds. If vomiting precedes thirst, use Zhu Ling Tang. If thirst precedes vomiting, treat diaphragmatic water with Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction). Thirst wanting water, water immediately vomited, vomiting then thirst again is Shui Ni (Water Counterflow), caused by Heart meridian heat affecting Small Intestine; use Wuling San. If Shaoyin vomiting without thirst or dry retching, use Lizhong Tang without Baizhu (Atractodes Macrocephala Rhizome) added with Shengjiang. Vomiting with saliva/foam uses Wuzhuyu Tang. Taiyin/Jueyin may have vomiting; Taiyin uses Lizhong Tang, Jueyin uses Si Ni Tang added with Shengjiang. Above yin syndromes are Yin within Yin, using hot agents. Yang entering yin causes diarrhea not vomiting. Vomiting is upper/exterior; deep yang entry causes diarrhea. Post-recovery yang syndrome vomiting with no other cause is residual heat in Stomach; use Zhuye Shigao Tang or Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction).

Generally, Taiyang vomiting implies combined disease. Vomiting indicates disease moving inward, not pure Taiyang. Recall a case: Taiyang symptoms with incessant vomiting, warm agents failed. Knowing Taiyang was released by sweating, cold agents were needed. Taiyang vomiting, if not Yangming combined, is Shaoyang combined, heat-induced vomiting; warm agents were wrong. (Saw Taiyang great vomiting cured by exterior-releasing meds alone.)

Another case: Initial Taiyang symptoms with vomiting, family members similar, eight doses of Yangwei Tang effective. This was epidemic qi, a mixed condition, not standard Shang Han.