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(Suwen, Chapter 45: Lun Jue)
The Yellow Emperor asked: What is the reason for cold and heat manifestations in Jue syndrome? (Jue refers to rebellion or reversal. When Qi rebels, order is disrupted, leading to sudden dizziness, collapse, or loss of consciousness; this is termed Jue. My commentary: The onset of Jue syndrome begins in the feet, marking the initial stage of the disease. In severe cases, it presents as sudden collapse or violent Jue with immediate loss of consciousness; mild cases gradually recover, while severe cases may result in immediate death, representing a critical emergency. Later physicians failed to examine this in detail, merely equating cold or hot hands and feet with Jue, and some even identified foot qi disease as Jue, which is a significant error. Although Zhang Zhongjing distinguished between Cold Jue and Hot Jue, his discussion focused on the extremities, likely to differentiate cold and heat patterns in Shanghan (Cold Damage) disease, rather than addressing the concept of Jue as described in the Neijing. As stated in the Daqi Lun: "In sudden Jue, the patient does not speak with others." In the Tiaojing Lun: "When blood and Qi rush upward together, it results in Great Jue; Jue leads to sudden death-like state; if Qi returns, life is preserved; if not, death ensues." In the Miaci Lun: "When the five collaterals of the Hand and Foot Shaoyin, Taiyin, and Foot Yangming are exhausted, the body's pulses become heavy and the form loses sensation; the condition resembles a corpse, sometimes called Corpse Jue." Such conditions clearly go beyond mere cold/hot extremities or foot qi. Nowadays, most people do not understand Jue syndrome and misidentify it as Fengzhong (Wind Stroke). Fengzhong typically involves injury to meridians and collaterals, whereas Jue-ni (Reversal of Qi) is directly caused by the internal depletion of Essence and Qi. The exterior-interior and deficiency-excess aspects of the pathology must be distinguished. If the nomenclature is incorrect, it is no wonder that wind-treating methods are applied to Jue; among medical harms, none is greater than this. Here, Wind and Jue categories are listed side by side for readers to study and correct. Detailed discussions on Jue from various chapters can be found in Huitong Class, Disease 23.)

Qibo replied: When Yang Qi declines at the lower part, Cold Jue occurs; when Yin Qi declines at the lower part, Hot Jue occurs. (The vital energy of all things necessarily rises from below; thus, when Yin and Yang Qi decline at the lower part, Cold Jue and Hot Jue arise from this.)

The Emperor asked: Why does the heat of Hot Jue always begin at the sole of the foot? (The sole refers to the center of the foot. Heat is a Yang pathogen, yet it arises in the Yin region; hence the inquiry.)

Qibo said: Yang Qi originates from the lateral aspect of the five toes of the foot, while Yin meridians gather at the sole and converge at the foot center. Therefore, when Yang Qi prevails, the sole becomes hot. (The distal end of the toes is termed "biao" (exterior), where the Three Yang meridians originate. The sole and foot center are where the Three Yin meridians converge. If Yang Qi prevails, Yin Qi becomes deficient; Yang invades the Yin territory, so Hot Jue necessarily starts from the sole. In general, patients with Yin deficiency often experience heat in the soles of their feet.)

The Emperor asked: Why does the cold of Cold Jue necessarily start from the five toes and ascend to the knees? (The five toes are where Yang Qi originates; cold is a Yin pathogen, yet it ascends from the Yang region; hence the inquiry.)

Qibo said: Yin Qi originates from the medial aspect of the five toes, gathers below the knee, and converges above the knee. Therefore, when Yin Qi prevails, coldness extends from the five toes up to the knees. This coldness does not come from the exterior but arises from within. ("Li" refers to the interior/medial side, i.e., the sole. If Yin Qi prevails, Yang Qi becomes deficient; Yang cannot overcome Yin, so Cold Jue starts at the five toes and ascends with cold to the knees. However, this coldness is not acquired from outside but generated internally. Thus, in cases of Yang deficiency, coldness in the hands and feet invariably starts from the toe tips.)

The Emperor asked: What mistake leads to Cold Jue? (When Jue is about to manifest, if the hands and feet feel cold first, it is Cold Jue.)

Qibo said: The anterior yin (genitals) is the gathering point of Zongjin (tendons), and it is where the Taiyin and Yangming meridians combine. (The anterior yin refers to the genital organ. Zongjin refers to the convergence of numerous tendons. The three Yin meridities of the foot, along with Yangming, Shaoyang, Chong, Ren, Du, and Qiao meridians, all converge here, hence called Zongjin. Mentioning only the combination of Taiyin and Yangming emphasizes the importance of the water-grain storage organs. The Stomach is the sea of water-grain and Qi-blood, primarily moistening the Zongjin. Furthermore, Yin and Yang converge at the Zongjin, meeting at the Qichuan acupoint, with Yangming acting as the leader; thus, it is specifically mentioned to elucidate 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.) Such individuals possess strong constitutions but squander their vitality during autumn and winter through excessive sexual activity. The Qi in the lower jiao struggles upward but cannot replenish itself; essence overflows downward, and evil Qi follows it upward. (Those with robust constitutions rely on their strength, but during times of Yin dominance in autumn/winter, they indulge in desires, depleting Kidney essence. Deficiency of essence below causes Qi to seek compensation from above, leading to lower Qi struggling upward. Excessive consumption outpaces generation, preventing recovery. Overflow of essence leads to loss of Qi; loss of Qi leads to Yang deficiency; Yang deficiency allows Yin excess to become pathogenic, causing cold Qi to rebel upward.) The Qi becomes trapped in the middle jiao. (Qi here refers to the essence Qi and evil Qi mentioned earlier. The source of essence Qi lies in water-grain; the transformation of water-grain depends on the Spleen and Stomach. Therefore, conditions such as Cold Jue, lower Qi rebelling upward, and essence overflowing downward are all due to Qi being trapped in the middle. While water-grain resides in the Stomach and Mingmen is in the Kidney, regarding essence, Kidney essence transformation relies on the Stomach; regarding Fire and Earth, Yang Qi in Earth roots in Mingmen. Yin and Yang are inverted and interrelated. Thus, stating that Jue originates below and Qi is trapped in the middle clarifies the mutual dependence between upper and lower.) Yang Qi declines and fails to permeate and nourish the meridians. Yang Qi is daily diminished, leaving Yin Qi alone, resulting in cold hands and feet. (Yang Qi here refers to Yangming Stomach Qi. The four limbs receive Qi from the Stomach; thus, central Yang deficiency prevents permeation and nourishment of the meridians, causing cold extremities.)

The Emperor asked: How does Hot Jue occur? (When Jue is about to manifest, if both hands and feet are hot, it is Hot Jue.)

Qibo said: When wine enters the Stomach, the collateral vessels become full while the main meridians remain empty. (Wine is a liquid made from hot grains; its Qi is fierce and rapid, thus filling the collateral vessels first. Full collaterals and empty meridians indicate that wine damages Yin; Yang excess leads to Yin deficiency. For detailed meanings of wine, see Meridian Class 6 and Zang-Xiang Class 21.) The Spleen's function is to transport fluids for the Stomach. When Yin Qi is deficient, Yang Qi enters inward; when Yang Qi enters inward, the Stomach becomes disharmonious; when the Stomach is disharmonious, essence and Qi are exhausted; when essence and Qi are exhausted, the four limbs are not nourished. (The Spleen transports fluids for the Stomach; thus, wine entering the Stomach ultimately reaches the Spleen. Damp-heat in the Spleen leads to Spleen Yin deficiency and solitary Yang hyperactivity, causing Stomach disharmony. When both Spleen and Stomach are diseased, essence and Qi are exhausted, failing to nourish the meridians and limbs.) Such individuals likely engage in frequent drunkenness or sexual intercourse after full meals. Qi accumulates in the Spleen without dispersing; wine Qi and grain Qi contend, generating intense heat in the middle jiao. Consequently, heat pervades the body, presenting as internal heat and dark urine. Wine Qi is vigorous and fierce, causing Kidney Qi to decline daily while Yang Qi stands alone in excess, resulting in hot hands and feet. (Frequent drunkenness or sex after eating damages both the Spleen and Kidney, leading to Yin deficiency, hence hot extremities. Commentary: The two types of Jue in this chapter—one caused by relying on strength to squander vitality in autumn/winter, leading to Yang decline and Cold Jue; the other caused by frequent drunkenness or sex after eating, leading to essence exhaustion and Hot Jue—both result from alcohol and sexual indulgence damaging true Yuan Qi. Thus, the chapter first explains their origins, allowing one to discern the severity of Jue.)

The Emperor asked: Why does Jue sometimes cause abdominal fullness, sometimes sudden unconsciousness, and why does consciousness return after half a day or even a day? (Sudden unconsciousness refers to abrupt coma.)

Qibo said: When Yin Qi is excessive in the upper part, the lower part becomes deficient; lower deficiency leads to abdominal distension. (Excessive Yin Qi in the upper part fails to secure the lower part, causing lower deficiency. Yin deficiency below impairs the transformation of Spleen and Kidney Qi, resulting in abdominal fullness.) When Yang Qi is excessive in the upper part, lower Qi merges and rebels upward; rebellion causes Yang Qi to become chaotic; chaos in Yang Qi leads to loss of consciousness. ("Chong" means merging. Evil Qi refers to abnormal Qi flow. Excessive Yang Qi in the upper part causes lower Qi to merge and ascend; merging leads to rebellion, rebellion leads to chaos, chaos in Yang Qi causes the Spirit to lose its residence, resulting in sudden unconsciousness.)