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Jue (Reversal) has three main meanings: one refers to "reversal," meaning the Qi from the lower part reverses and moves upward; all instances referred to as "Jue Ni" (Reversal Cold/Numbness) fall into this category. The second refers to "extremity"; the Heat Jue and Cold Jue in this chapter refer to the extremities of cold and heat. The third refers to "coma or loss of consciousness"; the Yin excess and Yang disorder mentioned in this chapter leading to fainting fall into this category. However, what is commonly called Jue in later times is limited only to cold reversal of the hands and feet and loss of consciousness, which deviates from the original intent of the Classic. Regarding the Emperor's inquiry about the Jue of the Six Meridians in this chapter, Qibo's response first discusses the Jue of the Six Meridians, then the coma caused by Jue of the Six Meridians, and finally the Jue Ni of the Hand Six Meridians. Jue Ni is simply Jue; there are not two distinct entities. However, upon careful reading, the various symptoms described are actually miscellaneous diseases of each meridian complicated by Jue Ni. It elaborates to exhaust the meaning of Jue. It does not mean that outside of Jue there is Jue Ni, nor does it imply that the names of various Jues are different.

The Yellow Emperor asked: Why do some cases of Jue present with cold and others with heat? Qibo replied: When Yang Qi is deficient in the lower part, Cold Jue occurs; when Yin Qi is deficient in the lower part, Heat Jue occurs. (Note: Yang deficiency leads to cold, Yin deficiency leads to heat; Jue follows this principle as well, let alone other conditions.) The Emperor asked: Why does the heat sensation in Heat Jue always start from the soles of the feet? Qibo said: Yang Qi originates from the dorsal aspect of the five toes of the foot, while Yin meridians gather at the sole and converge at the center of the foot. Therefore, when Yang Qi prevails, the soles become hot. (Generally speaking, the Foot Taiyang Bladder Meridian emerges from the lateral end of the little toe, the Foot Shaoyang Gallbladder Meridian from the end of the second toe, and the Foot Yangming Stomach Meridian from the ends of the middle and big toes, all ascending along the dorsum of the foot. The Liver, Spleen, and Kidney Yin meridians gather at the sole and converge at the center of the foot. Due to Yin weakness, the soles feel hot. Note: Yin weakness allows Yang to prevail, but this is not a true excess of Yang Qi.) The Emperor asked: Why does the cold sensation in Cold Jue always spread from the five toes up to the knees? Qibo said: Yin Qi originates from the plantar aspect of the five toes, gathers below the knee, and converges above the knee. Therefore, when Yin Qi prevails, coldness spreads from the toes to the knees. This coldness does not come from the exterior but arises from within. (This is also a general description. The Foot Taiyin Spleen Meridian originates from the medial end of the big toe, the Foot Jueyin Liver Meridian from the hairline at the tip of the big toe, and the Foot Shaoyin Kidney Meridian from below the little toe, slanting toward the center of the foot. All ascend along the medial aspect of the foot, up the thigh interior into the abdomen, hence gathering below and converging above the knee. Note: Yang deficiency leads to Yin prevalence, and Yin prevalence leads to cold. Since the root of cold is Yang deficiency, it is said to arise from within.)

The Emperor asked: What mistake leads to Cold Jue? Qibo said: The anterior perineum is where the Zongjin (Tendon Sheath/Mass of Tendons) gathers, and it is the confluence of the Taiyin and Yangming meridians. (Zongjin supports the area below the navel and connects to the genitalia, hence it is said that the anterior perineum is where Zongjin gathers. The Taiyin Spleen Meridian and Yangming Stomach Meridian run close to Zongjin, hence they are said to converge here. Note: The commentary likely refers to the anatomical position of the meridians.) How could one not know that the human body relies on water and grain for nourishment? As stated in previous chapters, the Yangming governs moistening Zongjin, so mentioning the convergence of Taiyin and Yangming is appropriate. In spring and summer, Yang Qi is abundant and Yin Qi is scarce; in autumn and winter, Yin Qi is prevalent and Yang Qi declines. (This is the constant way of Heaven.) A person of robust constitution who overuses their essence during autumn and winter causes the lower Qi to contend upward without recovery, leading to the overflow of essence downwards. Pathogenic Qi then follows upward. Qi becomes stagnant in the middle, Yang Qi declines and cannot permeate and nourish the collaterals. Yang Qi diminishes day by day, leaving only Yin Qi. Thus, the hands and feet become cold. ("Overuse" refers to excessive sexual activity depleting essence. Note: Autumn and winter are suitable for nourishing Yin. Overuse leads to Yin deficiency and floating Yang, causing upward contention and essence leakage. Righteous Qi is depleted, pathogenic factors move, and True Qi declines. The four limbs are the root of all Yang. Once Yang declines, Yin prevails exclusively, so the hands and feet are unwarmed and cold.)

The Emperor asked: How is Heat Jue formed? Qibo said: When wine enters the stomach, the Luo (Collateral) vessels become full while the Jing (Main) meridians become empty. The Spleen governs transporting 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. (Note: The main branch is the Jing, the side branches are the Luo. Wine is fierce and harsh, disturbing floating Qi and consuming True Qi, thus making Luo vessels full and Jing meridians empty. The Stomach receives it, but the Spleen operates it. Spleen transport activates Qi, which enters the Stomach vacuously. The Stomach is unsettled, water and grain lose nourishment, cannot transform into Qi and Blood, and the four limbs lose support.) Such a person must frequently engage in sexual intercourse after getting drunk or eating until full. Qi gathers in the Spleen and cannot disperse. Wine Qi and Grain Qi struggle against each other, creating intense heat in the center. Thus, heat pervades the body, causing internal heat and red urine. The nature of wine is vigorous and harsh, causing daily decline of Kidney Qi and exclusive prevalence of Yang Qi. Thus, the hands and feet become hot. (Sexual intercourse after drunkenness/fullness causes internal loss of essence, central deficiency allowing heat to enter, leading to Kidney decline, Yang excess and Yin deficiency, hence heat arises in the hands and feet. Note: Why does Qi gather in the Spleen after drunkenness and sex? The Spleen governs transformation and transportation but requires Qi from the Mingmen (Gate of Life) to operate without stagnation. Now, drunkenness and sex cause severe Kidney deficiency, leaving no Qi in Mingmen to assist the Spleen, so Qi gathers and does not disperse. Undispersed Qi causes internal heat obstruction and Yang excess. Yang excess dries up Kidney Water and allows Fire to act, moving outward to the Yang aspects, hence all four limbs become hot.)

The Emperor asked: Why does Jue sometimes cause abdominal fullness, or sudden unconsciousness, with recovery taking half a day to a day? Qibo said: When Yin Qi is excessive in the upper part, the lower part becomes deficient. Lower deficiency leads to abdominal fullness... Abdominal fullness causes lower Qi to weigh down and reverse upward, with pathogenic Qi reversing. Reversal leads to Yang Qi disorder. Yang Qi disorder leads to loss of consciousness. (Note: Yang is clear, Yin is turbid. Clear Qi ascends, turbid Qi descends, ensuring smooth flow without reversal. Jue with abdominal fullness and unconsciousness indicates turbid Yin rising and chaotic Yang, hence Jue and unconsciousness. Wang Bing's edition adds "Yang Qi excessive in the upper" after "abdominal fullness." The *Jia Yi Jing* uses only "abdominal fullness," which is correct. Follow this. Also, Wang Bing's note interpreting "Yin" as "Foot Taiyin Qi" is erroneous.)

The Emperor said: Excellent! I wish to hear the clinical manifestations and pathological states of Jue of the Six Meridians. Qibo said: Jue of the Greater Yang (Taiyang) presents with swelling of the head and heaviness, inability to walk, and falling down. (Foot Taiyang Bladder Meridian originates from the inner canthus, ascends to the forehead and vertex. Branches go to the supraorbital angle. The main trunk enters the brain, exits at the nape, runs along the shoulder medial to the spine, reaches the waist, enters the muscle layer, connects to the Kidney, and belongs to the Bladder. Branches descend through the buttocks into the popliteal fossa. Other branches descend through the calf, pass the hip joint, follow the posterior lateral thigh, merge in the popliteal fossa, descend through the calf, emerge behind the lateral malleolus, follow the Jinggu point, and end at the lateral side of the little toe. Thus, Jue manifests these external signs.)

Jue of the Yang Ming (Stomach) presents with manic epilepsy, desire to run and shout, abdominal fullness preventing sleep, flushed and hot face, hallucinations, and delirious speech. (Foot Yangming Stomach Meridian originates between the nose and cheekbones, descends along the lateral nose, enters the upper teeth, emerges around the lips, crosses the chin, follows the jawline to Daying, passes Jiache, ascends before the ear, passes Guest Master, follows the hairline to the forehead. Branches descend from Daying to Renying, follow the throat, enter the Supraclavicular Fossa, descend through the diaphragm, belong to the Stomach, and connect to the Spleen. The main trunk descends from the Supraclavicular Fossa along the medial breast, lateral to the navel, into the Qi Street. Branches originate from below the stomach, run inside the abdomen to the Qi Street, descend to the thigh, reach the Patella, follow the lateral leg, enter the foot, and reach the space between the middle toes. Branches diverge below the knee to the lateral side of the middle toe. Another branch enters the big toe. Thus, Jue manifests these signs.)

Jue of the Shaoyang (Gallbladder) presents with sudden deafness, swollen and hot cheeks, hypochondriac pain, and immobility of the thigh. (Foot Shaoyang Gallbladder Meridian originates from the outer canthus, ascends to the corner of the head, descends behind the ear, follows the neck anterior to the Hand Shaoyang, reaches the shoulder, crosses behind the Hand Shaoyang, enters the Supraclavicular Fossa. Branches enter the ear, exit before the ear, and reach the outer canthus. Branches descend from the outer canthus to Daying, merge with Hand Shaoyang at the temple, descend to Jiache, join the neck and Supraclavicular Fossa, descend into the chest, pierce the diaphragm, connect to the Liver, belong to the Gallbladder, follow the hypochondrium, emerge at the Qi Street, circle the pubic region, and enter the hip joint. The main trunk descends from the Supraclavicular Fossa under the axilla, follows the chest past the costal margin, merges in the hip joint, follows the lateral thigh, emerges at the lateral knee, descends anterior to the fibular head, reaches the end of the fibula, emerges anterior to the lateral malleolus, follows the dorsum of the foot, and ends at the second toe. Thus, Jue manifests these signs.)

Jue of the Taiyin (Spleen) presents with abdominal distension, difficulty defecating, anorexia, vomiting after eating, and inability to sleep. Foot Taiyin Spleen Meridian originates from the tip of the big toe, ascends along the medial knee and thigh, enters the abdomen, belongs to the Spleen, connects to the Stomach, ascends through the diaphragm, flanks the pharynx, connects to the root of the tongue, and scatters under the tongue. A branch rises from the Stomach through the diaphragm to the Heart. Thus, Jue manifests these signs.

Jue of the Shaoyin (Kidney) presents with dry mouth, red urine, abdominal fullness, and heart pain. Foot Shaoyin Kidney Meridian ascends along the medial thigh, penetrates the spine, belongs to the Kidney, and connects to the Bladder. The main trunk ascends from the Kidney through the Liver and Diaphragm, enters the Lung, follows the throat, and flanks the root of the tongue. A branch emerges from the Lung, connects to the Heart, and pours into the Chest. Thus, Jue manifests these signs.

Jue of the Jueyin (Liver) presents with swelling and pain in the lower abdomen, abdominal distension, difficulty urinating and defecating, preference for lying down, bent knees, contraction and swelling of the genitalia, and heat in the Yin aspect. Foot Jueyin Liver Meridian starts one cun above the medial malleolus, ascends eight cun crossing behind the Taiyin, follows the medial knee, travels along the medial thigh, enters the pubic region, circles the genitalia, reaches the lower abdomen, flanks the Stomach, belongs to the Liver, connects to the Gallbladder, and ascends through the Diaphragm. Thus, Jue manifests these signs. Excess is drained, deficiency is tonified, and neither excess nor deficiency is treated by selecting points from the affected meridian. (Neither excess nor deficiency means pathogenic Qi is not excessive and True Qi is not deficient; in such cases, needle retention time is adjusted according to meridian methods. Note: The above text is from the ancient version. From Taiyin Jue Ni to the end, Quanyuanqi's version was in Volume 9, moved here by Wang Bing.)

Taiyin Jue Ni presents with calf cramps and spasms, heart pain radiating to the abdomen. (Note: Foot Taiyin Meridian originates from the big toe, follows the tibia, enters the Heart and abdomen, hence these symptoms.)

Shaoyin Jue Ni presents with false fullness, vomiting and changes, and passage of clear watery stool. (Note: Among the Five Zang, the Kidneys are unique. The left is Yin, the right is Yang within Yin; the left belongs to Water, the right contains hidden Fire. It is the root of Qi, the Gate of Life, and the gate of the Stomach. When Kidney Qi is full, mild fire stores in the Dantian, harmonizing whole-body Qi without cold stagnation. False fullness indicates Qi failure to transport. Vomiting indicates Cold invading the Stomach. Clear stool indicates Spleen Cold failing to secure. This is due to Kidney deficiency and weak Mingmen Fire failing to warm the Dantian. Ignorant practitioners treat the Spleen instead of the Kidney, which is inappropriate.)

Jueyin Jue Ni presents with spasms, lower back pain, false fullness, urinary retention, and delirious speech. (Quanyuanqi said: "Delirious speech is talking alone due to Qi deficiency." Note: Jueyin corresponds to the Liver, which governs tendons. Liver disease causes tendon spasms, leading to limited movement and lower back pain. Liver Qi stagnation causes false fullness. The Liver Meridian circles the genitalia, causing urinary retention. Wind evil lurking in the Liver causes delirium.)

When all Three Yin meridians experience Jue Ni, resulting in inability to pass stool or urine, causing cold hands and feet, death occurs within three days. (Note: Internal cold usually causes diarrhea. Here, constipation and cold extremities indicate severe Yin coagulation and closure, with exhaustion of True Qi. How can one survive?)

Taiyang Jue Ni presents with stiffness and falling, hematemesis, and frequent epistaxis. (Note: The Bladder Meridian originates at the inner canthus, follows the spine to the brain. It governs Qi and Fire. Internal closure of Qi causes stiffness and falling. Ascending Fire causes bleeding. Taiyang governs the exterior, hence these Jue signs.)

Shaoyang Jue Ni presents with dysfunction of joints. Those with joint dysfunction cannot walk or turn their necks. If intestinal abscess develops, it is incurable. If fright occurs, death ensues. (Note: The Gallbladder is the Fu organ of the Liver. The Liver governs tendons, which bind bones and facilitate joints. Liver-Gallbladder disease causes lumbar spasm. This is a half-exterior/half-interior condition. Intestinal abscess involves both interior and exterior, causing mental confusion and death.)

Yangming Jue Ni presents with wheezing and cough, fever, fright, epistaxis, and hematemesis. (Note: Yangming has abundant Qi and Blood. Stomach Fire surging to the Lung causes cough. Fire moving through the Three Yang causes fever. Fire's active nature causes fright and blood instability. This is Heat Jue.)

Hand Taiyin Jue Ni presents with false fullness, cough, and frequent vomiting of froth. (Note: The Lung governs Qi, so disease causes false fullness and cough. Cold in the Lung causes vomiting of frothy sputum. Froth refers to light, white, floating phlegm-water.)

Hand Jueyin (Pericardium) and Shaoyin Jue Ni present with heart pain radiating to the throat. Fever indicates death and incurability. (Note: The Heart and Pericardium belong to Fire. Rising Fire causes throat pain (deficient fire). Deficient Fire rising with fever indicates Yin exhaustion failing to anchor Yang, hence death.)

Hand Taiyang Jue Ni presents with deafness, tearing, inability to turn the neck, and inability to bend or extend the waist. (Note: The Small Intestine belongs to Fire. Ascending Fire causes deafness. The Small Intestine Meridian reaches the inner canthus, causing tearing. The phrases "cannot turn neck" may be repetitions from earlier text as they do not match the meridian pathology.)

Hand Yangming and Shaoyang Jue Ni present with Bi syndrome of the throat, swollen pharynx, and spasms. (Note: Spasms refer to wind diseases. Large Intestine and Sanjiao meridians ascend from the Supraclavicular Fossa to the neck, hence these symptoms. Quanyuanqi wrote "spasms" (Jing), Wang Bing mistakenly wrote "aphonia" (Yin). Later generations confused the two due to this error.)