Library

(Original) "Jue" (extinction/abandonment) refers to drawing in food to save oneself. "Zhong" (middle) speaks of the stomach. "Si" (death) means that all things cannot grow without soil.
Translation: The patient abandons normal intake and draws in food to sustain life. Here, "Zhong" refers to Stomach Qi. "Death" implies that just as all things cannot grow without soil, life cannot persist without Stomach Qi.

Cheng Zhi stated: A slow pulse indicates cold; it is inappropriate to use cold-natured medicines further, lest it lead to the complication of "Chu Zhong" (false recovery). If the Middle Qi is eradicated by Yin-cold, the rootless Yang Qi in the Stomach will be completely cleared, leading the patient to seek relief through food. Thus, this is a death sign.

In Shaoyang disease, if there is initial Jue (cold extremities) followed by fever and diarrhea, the diarrhea must stop spontaneously. If Jue returns, the diarrhea will recur.
[Annotation] Cold extremities (Jue) belong to Yin. Fever belongs to Yang. Initial Jue followed by fever, with spontaneous cessation of diarrhea, indicates that Yin pathogen recedes while Yang advances. Recurrence of Jue with diarrhea indicates that Yang recedes while Yin advances. If heat predominates over cold extremities, even severe illness may heal; if cold extremities predominate over heat, even mild illness may worsen. Thus, the alternation of Jue and fever is the mechanism of Yin-Yang advance and retreat, determining life and death.
[Collected Notes] Wang Hu stated: Jueyin represents the end of Yin. The Yang Qi in the Jueyin channel is very weak. Therefore, regardless of whether the syndrome is Yin or Yang, or whether the pathogen is cold or heat, once it invades this channel, Jue invariably occurs. "Jue" means reversal, starting from the hands and feet. Here, "initial Jue" means Jue occurring at the onset. If Jue is accompanied by diarrhea and fever, it indicates Yang recovery, and diarrhea must stop spontaneously.

In Shaoyang disease, initial Jue followed by fever leads to spontaneous cessation of diarrhea. However, if sweating occurs instead, accompanied by throat pain, Bi obstruction of the throat will ensue. If there is fever without sweating, and diarrhea does not stop, pus and blood will inevitably appear in the stool. If pus and blood appear in the stool, the throat will not be obstructed.
[Annotation] This section elaborates on the previous clause to reveal the syndromes. Initial Jue followed by fever leads to spontaneous cessation of diarrhea. When Jue resolves and diarrhea stops, if the heat subsides, the disease is about to heal. If Jue resolves and diarrhea stops, but heat persists with sweating, this indicates that the Jueyin disease has transformed into heat from Yang. The pathogen follows its own channel upward, causing throat pain and Bi obstruction. If Jue resolves with fever, no sweating, and persistent diarrhea, this indicates that Jueyin heat pathogen, driven downward by diarrhea, damages the blood in the vessels, inevitably leading to pus and blood in the stool. If pus and blood appear in the stool, the throat is not obstructed, meaning the heat pathogen moves downward via diarrhea and no longer attacks the throat causing pain. Conversely, if diarrhea stops and the throat becomes obstructed, it means the heat pathogen has moved upward, attacking the throat, and thus no longer causes diarrhea below.
[Collected Notes] Yu Chang stated: Initial Jue followed by fever and cessation of diarrhea indicates the disease is about to heal. Instead, sweating and throat pain occur, indicating excess heat pathogen attacking the throat causing Bi obstruction. Although there is fever without sweating, since Yang has returned, diarrhea should stop spontaneously. If it does not stop, the absence of sweating clearly shows the pathogen cannot exit outward; heat is constrained inside, inevitably leading to pus and blood in the stool. If pus and blood appear, the throat is not obstructed, showing that heat constrained inside does not manifest on the exterior; located below, it does not manifest above.
Wang Hu stated: Throat pain indicates heat damaging the Qi aspect of the Upper Jiao. "Bi" means closure. Severe throat pain causes the throat to close and become obstructed because the Jueyin channel passes behind the throat and enters the nasopharynx. No sweating, persistent diarrhea, and pus/blood in stool indicate heat damaging the Blood aspect of the Lower Jiao. Heat pouring downward does not affect the upper part, hence "the throat is not obstructed."

Diarrhea with a rapid pulse, slight fever, and sweating indicates spontaneous healing. If the pulse becomes tight again, the disease is unresolved.
[Annotation] Diarrhea in Jueyin with a rapid pulse indicates heat diarrhea. If the heat is slight and sweating occurs, it indicates the pathogen is weak and resolving; diarrhea will stop spontaneously, leading to self-healing. If the pulse becomes tight again, it indicates the exterior pathogen remains strong and unresolved.
[Collected Notes] Cheng Wuji stated: Diarrhea is a Yin disease. A rapid pulse is a Yang pulse. Yin disease presenting with a Yang pulse indicates survival. Slight fever and sweating indicate Yang Qi is unblocked; diarrhea will heal spontaneously. All tight pulses indicate cold. If the pulse becomes tight again, cold pathogen remains strong, hence "unresolved."
Shen Mingzong stated: These clauses refer to cases of Jue with diarrhea and pus/blood in stool. Observing various pulses such as Excess-Large, Floating-Rapid, Weak, Deep-Slippery, Wiry-Tight, or Surging-Long allows differentiation of Deficiency, Excess, Cold, and Heat, revealing whether healing is imminent. This is truly the subtle essence of disease examination.

Diarrhea with slight fever and thirst, and a weak pulse, indicates spontaneous healing.
[Annotation] In Jueyin diarrhea, great heat with thirst and a strong pulse indicates both pathogen and heat are exuberant. Now, diarrhea with slight fever and thirst, and a weak pulse, indicates the pathogenic heat has declined. Since the heat has declined, spontaneous healing is expected.
[Collected Notes] Fang Youzhi stated: Slight fever indicates gradual return of Yang. Thirst indicates internal dryness has not yet recovered. Weak pulse indicates pathogen retreat. "Spontaneous healing" means no treatment is required.
Cheng Zhi stated: Diarrhea heals when Yang returns and pathogen weakens. Slight fever and thirst show the syndrome has turned Yang; weak pulse shows pathogen has retreated, so it heals without treatment. If diarrhea presents with great heat and surging pulse, it is an adverse sign.

Diarrhea with a rapid pulse and thirst indicates spontaneous healing. If it does not improve, pus and blood will inevitably appear in the stool due to internal heat.
[Annotation] This clause complements the previous one to detail variations. Diarrhea with rapid pulse and thirst indicates internal heat. If there is no body heat, the pathogen has weakened, allowing for spontaneous healing. If diarrhea with rapid pulse and thirst persists for a long time without improvement, even without body heat, pus and blood will appear in the stool because internal heat damages Yin fluids.
[Collected Notes] Fang Youzhi stated: Rapid pulse elucidates the preceding text regarding slight fever.
Cheng Yingmao stated: Rapid pulse and thirst indicate Yang overcoming Yin, hence spontaneous healing. If it does not improve, Yin deficiency allows heat to enter. As the Classic states: "If pulse remains rapid and diarrhea persists, it will certainly involve heat and produce pus and blood in stool."

Diarrhea, with the Cun (inch) pulse surprisingly floating and rapid, and the Chi (cubit) pulse naturally slippery/choppy, will inevitably produce pus and blood in the stool.
[Annotation] In Jueyin heat diarrhea, the Cun pulse should be Deep-Rapid. Now, the Cun pulse is surprisingly Floating-Rapid, indicating heat is on the exterior rather than interior. The Chi pulse being naturally Choppy indicates that the exterior heat has not resolved; taking advantage of diarrhea, it enters the interior, damaging Yin. Heat and blood stasis combine, inevitably leading to pus and blood in the stool.
[Collected Notes] Yu Chang stated: Floating-Rapid pulse, if it were pathogen returning to the exterior, the Chi pulse would be harmonious. Now, the Chi pulse is naturally Choppy, indicating heat pathogen knotting in the Yin aspect. Although the Cun position yields a Yang pulse, ultimately the Yin pathogen will exit via the lower orifice, producing pus and blood in stool.
Wang Hu stated: This clause describes the manifestation of diarrhea transforming into pus and blood. Heat diarrhea with a rapid pulse is not abnormal; a Floating pulse is abnormal. This clause discusses the condition without specifying treatment; it is appropriate to substitute Zhang Zhongjing's Huangqin Decoction.

Diarrhea with a Deep-Wiry pulse indicates tenesmus. A Large pulse indicates the disease has not stopped; a Weak-Rapid pulse indicates it is about to stop spontaneously. Even with fever, death will not occur.
[Annotation] This elaborates on the previous clause regarding diarrhea with pus and blood. Deep pulse indicates Interior. Wiry pulse indicates tension/urgency. "Xia Zhong" (lower heaviness) refers to tenesmus. Diarrhea with Deep-Wiry pulse causes Li Ji Hou Zhong (tenesmus). Generally, in diarrhea, fever with a Large pulse indicates strong pathogen, meaning the disease has not stopped. Weak-Rapid pulse indicates declining pathogen, meaning it is about to stop; even with fever, death will not occur. From this, we know that dysentery with Large pulse and body heat will result in death.
[Collected Notes] Yu Chang stated: Diarrhea with Deep-Wiry pulse indicates Li Ji Hou Zhong, forming the syndrome of "Zhi Xia" (dysentery), now called Li syndrome. Large pulse refers to the Large quality within the Deep-Wiry; Weak-Rapid refers to the Weak-Rapid quality within the Deep-Wiry.

Diarrhea with desire to drink water indicates heat; Baitouweng Tang is indicated. Heat diarrhea with tenesmus is treated with Baitouweng Tang.
[Annotation] This follows the previous clause to reveal the treatment. Desire to drink water in diarrhea indicates heat diarrhea depletes fluids, seeking water to moisten dryness. Heat diarrhea with tenesmus indicates heat damages Qi stagnation, causing Li Ji Hou Zhong and pus/blood in stool. Both are treated with Baitouweng Tang because it is greatly bitter and cold; cold overcomes heat, and bitterness dries dampness.
[Collected Notes] Cheng Zhi stated: In Shaoyin spontaneous diarrhea with thirst, there are also cases of deficiency drawing water to save oneself. One must distinguish based on urine color and pulse speed. This clause refers to internal knotting of heat pathogen. Internal heat knotting causes tenesmus, so purely bitter-cold herbs are used to overcome heat and thicken the intestines.

Baitouweng Tang Formula
Baitouweng (3 liang), Huanglian (remove whiskers, 3 liang), Huangbai (remove bark, 3 liang), Qinpi (3 liang).
These four ingredients are boiled in 7 sheng of water to obtain 3 sheng. Strain and take 1 sheng warm. If not improved, take another 1 sheng.
[Formula Analysis] All three Yin channels have diarrhea syndromes. Spontaneous diarrhea without thirst belongs to Taiyin; spontaneous diarrhea with thirst belongs to Shaoyin. Only Jueyin diarrhea differs: cold types present with Jue, no thirst, and undigested food in stool; heat types present with excessive thirst, diarrhea, tenesmus, and pus/blood in stool. This heat diarrhea with tenesmus is caused by fire constraint and damp steaming, foul qi rushing to the large intestine, causing heavy, difficult defecation, as described in the *Neijing* as "sudden purging with urgent pressure." The Sovereign herb Baitouweng is cold, bitter, and acrid; the Minister herb Qinpi is cold, bitter, and astringent. Cold overcomes heat, bitterness dries dampness, acridity disperses fire constraint, and astringency arrests tenesmus. Assistant herb Huanglian clears Upper Jiao fire, stopping thirst; Envoy herb Huangbai drains Lower Jiao heat, eliminating diarrhea. There are two methods for treating Jueyin heat diarrhea: early stage uses this formula's bitterness to drain fire, dry with bitterness, disperse with acridity, and secure with astringency—this is the method of treating heat with cold. Chronic diarrhea uses Wumei Wan's sourness to gather fire, assisted by bitter-cold, mixed with warm-tonics—this is the method of counteracting and following, acting according to what is beneficial, regulating Qi to achieve balance.

Shaoyang diarrhea, occurring more than ten times a day, with a surprisingly Excess pulse, indicates death.
[Annotation] Shaoyang diarrhea occurring many times a day indicates deficient Righteous Qi; the pulse should be Deficient. Now it is surprisingly Excess, indicating Exuberant Pathogen. Deficient Righteous Qi and Exuberant Pathogen indicate death.
[Collected Notes] Cheng Wuji stated: Diarrhea is Interior Deficiency; pulse should be Weak-Fine. Surprisingly Excess means the disease overcomes the Zang organs, hence death. Pulse not corresponding to disease is what is meant here.
Zheng Zhongguang stated: An Excess pulse shows Stomach Qi has lost its gentle quality, and only the True Zang pulse appears. Pathogen is exuberant, Righteous Qi has collapsed.

Shaoyang disease after six or seven days, initially no diarrhea, suddenly develops fever, diarrhea, and incessant sweating indicates death, due to having Yin but no Yang.
[Annotation] Six or seven days into Shaoyang disease is when pathogen transmits to Jueyin. Initially Jue without diarrhea indicates Yin pathogen is not strong; if fever occurs, it is not fatal. Now, after six or seven days without diarrhea, sudden onset of diarrhea, fever, and incessant sweating indicates Yin exuberance in the Interior and Yang collapse on the Exterior. Thus, there is Yin but no Yang, and death is certain.
[Collected Notes] Fang Youzhi stated: Fever with diarrhea indicates Interior Yin exuberance, hence "having Yin." Incessant sweating indicates Exterior Yang extinction, hence "no Yang."
Cheng Zhi stated: Sudden profuse diarrhea with sweating is a Yang-collapse death sign. After six or seven days without diarrhea, sudden fever and diarrhea leading to incessant sweating indicates complete Exterior Yang and Interior Yin, with True Yang vanishing instantly.
Wang Hu stated: Cold invading Jueyin for six or seven days should imply Jue for six or seven days; omitting "Jue" is ellipsis. If Jue occurred with diarrhea, it would stop; Yang has not failed and can resist pathogen. If fever occurs, even with diarrhea, it should stop. Now fever and diarrhea arrive suddenly together, plus incessant sweating, indicating this heat is not Yang return but Yang collapse. Hence, diarrhea and sweating occur together.
Zhanglingshao stated: Jueyin disease fever is not fatal. Fever leading to death has three signs: restlessness unable to lie down, unremitting Jue, and incessant sweating.

Fever with Jue, and diarrhea after seven days, is difficult to treat.
[Annotation] This elaborates on the meaning of fever with Jue. Fever with Jue for seven days, if Jue resolves and diarrhea stops, can resolve spontaneously. Now, fever with Jue for seven days with persistent diarrhea is difficult to treat. The previous clause had Yin but no Yang, hence fatal; this clause has Yin exuberance with Yang failing to return, hence difficult to treat.
[Collected Notes] Fang Youzhi stated: Jue for seven days with diarrhea indicates Yin exuberance and Yang failing to return.
Zhang Lu stated: Jue/Diarrhea and Heat are mutually exclusive forces. Fever with Jue for seven days means heat stays hot, Jue/diarrhea stay cold. Yin and Yang deviate excessively with no hope of coordination. Thus, even without restlessness, it is difficult to treat. Treating heat worsens Jue/diarrhea; treating Jue/diarrhea worsens heat, until both Yin and Yang are exhausted.

Diarrhea with Deep-Slow pulse, slightly red face, slight body heat, and undigested food in stool will inevitably lead to Yu Mao (depression/dizziness) and sweating before resolution. The patient will have slight Jue. This is because the face shows Dai Yang (floating Yang), and the lower part is deficient.
[Annotation] Deep-Slow pulse and undigested food in stool indicate Interior Yin-Cold. Slightly red face and slight body heat indicate Exterior Yang-Heat. With Interior Yin-Cold and Exterior Yang-Heat, Yin can transform and resolve with Yang's help. However, before resolution, the patient will experience Yu Mao and sweating. This is because the floating Yang on the face and the deficient Yin from diarrhea harmonize, leading to resolution. This is not Yin rejecting Yang above; thus, although dizzy, Jue is slight, unlike severe dizziness and Jue in unresolved cases.
[Collected Notes] Yu Chang stated: Diarrhea with Deep-Slow pulse is Interior Cold. Slightly red face and slight heat indicate concurrent exterior pathogen, resolving via sweating. But Dai Yang syndrome must present with slight Jue; this hides a critical danger, requiring unusual treatment methods. All six channels have diarrhea; Shaoyin and Jueyin are difficult. Pathogen entering interior causes deep diarrhea leading to Jue; deep Jue causes diarrhea. Thus, the Classic details diarrhea in Shaoyin and Jueyin. Treatment principles can be integrated for both.
Wang Hu stated: Yu Mao is dizziness in the head/eyes, indicating Yang can overcome cold pathogen, Inner Yang returns, and Exterior-Harmony is achieved, leading to resolution. Sweating indicates Yang return, Interior-Cold disperses, and Ying-Wei harmonize. It is not induced by exterior-releasing drugs.

Undigested food in stool, Interior-Cold with Exterior-Heat, sweating, and Jue are treated with Tongmai Sini Tang.
[Annotation] This complements the previous clause to reveal treatment. Undigested food in stool is Interior-Cold; slight body heat is Exterior-Heat. The previous clause had no-sweat, flushed face, allowing expectation of resolution via sweating. This clause has sweating and Jue, revealing Yang-collapse complication. Thus, Tongmai Sini Tang is used to rescue Yang to overcome Yin.
[Collected Notes] Fang Youzhi stated: Diarrhea indicates Interior-Cold, Yin not guarding; Exterior-Heat causes sweating, Yang not securing. Tongmai Sini rescues Exterior/Interior, unblocks Blood/Qi, and restores Yin/Yang.
Yu Chang stated: Previous clause differentiates syndrome; this clause prescribes medicine, elucidating each other. Also, Shaoyin diarrhea with undigested food and red face already used this method.
Wu Renju stated: Xie Re (collateral heat) diarrhea also presents with undigested food, due to pathogen heat failing to digest grains. Distinction lies in pulse Yin/Yang and Deficiency/Excess.

Profuse sweating, heat not abating, internal cramping, limb pain, plus diarrhea, Jue, and aversion to cold are treated with Sini Tang.
[Annotation] Profuse whole-body sweating should abate heat. If heat persists without other symptoms, pathogen is incomplete and unresolved. Now, profuse sweating, heat persists, plus cramping, limb pain, diarrhea, Jue, and aversion to cold, indicates Yang collapse on Exterior and Cold exuberance in Interior. Thus, Sini Tang is used to warm meridians to overcome cold, restore Yang, and arrest sweating.
[Collected Notes] Fang Youzhi stated: Profuse sweating indicates Yang deficiency and insecure Exterior; heat not abating means pathogen not removed; internal cramping and limb pain indicate fluid loss and bone-Qi obstruction; diarrhea, Jue, aversion to cold indicate Yang collapse and severe Interior Yin-Cold.
Cheng Zhi stated: Post-profuse sweating with diarrhea and Jue requires urgent Yang restoration. Profuse sweating with persistent heat fears True Yang flying away. Internal cramping, limb pain, plus diarrhea, Jue, aversion to cold, indicates pure Interior Yin-Cold.
Cheng Yingmao stated: Why is this not in the Yang-collapse death category? Yang collapse results from incessant sweating. Here, internal cramping and limb pain indicate sweating has stopped, Yang has not collapsed, but aversion to cold exists, so warming method is applicable.

Profuse sweating, or profuse diarrhea with cold extremities, are treated with Sini Tang.
[Annotation] Profuse sweating with inability to retain sweat is Guizhi Jia Fuzi Tang syndrome. Profuse diarrhea with persistence is Lizhong Jia Fuzi Tang syndrome. Now, profuse sweating plus profuse persistent diarrhea with cold extremities indicates Yang collapse on Exterior and Cold exuberance in Middle. Guizhi and Lizhong cannot treat this; Sini Tang is needed urgently to restore Yang, overcome Yin, stop sweating/diarrhea, and resolve Jue, offering a chance of survival. The above three clauses are concurrent Jueyin-Shaoyin diseases; due to severe Shaoyin cold, they are treated according to Shaoyin principles.
[Collected Notes] Yu Chang stated: No conflicting Exterior-Heat makes Interior Yin-Cold clear. However, profuse sweating and diarrhea deplete Yin fluids. At this moment, rescuing Yang is urgent; only after Yang returns can Yin be slowly restored.

Diarrhea with cold extremities and absent pulse: if moxibustion fails to warm, and pulse does not return, but slight panting occurs, death ensues. After diarrhea, absent pulse and cold extremities: if pulse temporarily returns and extremities warm, survival; if pulse does not return, death.
[Annotation] Diarrhea with cold extremities and absent pulse indicates Yin without Yang. Even with Fuzi/Sini formulas, Yang may not return quickly; urgent moxibustion on Jueyin is needed to unblock Yang. If pulse returns and extremities warm, survival; if pulse does not return, extremities remain cold with slight panting, indicating Qi exhaustion and Yang collapsing upward, hence death.
[Collected Notes] Fang Youzhi stated: Panting is short-breathed and discontinuous, indicating Yang Qi decay and extinction.
Cheng Zhi stated: Shaoyin diarrhea, Jue, absent pulse, taking Baitong Tang: sudden pulse emergence is death, gradual continuation is survival. Jueyin diarrhea, Jue, absent pulse, using moxibustion: temporary pulse return is survival, non-return is death. Seeking Yang requires finding the faintest trace in the Kidneys to use warm moxibustion as a bridge!

Shaoyang fever, diarrhea, Jue, restlessness unable to lie down indicates death. Shaoyang fever, severe diarrhea, unremitting Jue indicates death.
[Annotation] Shaoyang fever, diarrhea, and Jue with restlessness unable to lie down indicates Cold exuberance in Interior disturbing solitary Yang. Or, fever with severe diarrhea and unremitting Jue, even without restlessness, indicates Exterior Yang scattering and Interior Yang collapsing, hence both are fatal.
[Collected Notes] Cheng Wuji stated: Shaoyang fever, pathogen on Exterior; diarrhea and Jue, Yang deficiency; restlessness unable to lie, disease overcomes Zang, hence death. *Jingui Yaolue* states: Six Fu organs Qi failure on Exterior causes cold hands/feet; Five Zang organs Qi failure on Interior causes uncontrollable diarrhea. Shaoyang fever indicates pathogen dominance; severe diarrhea and unremitting Jue indicate Fu/Zang Qi failure, hence death.
Cheng Zhi stated: Jueyin disease fever is not fatal because fever expels pathogen to Exterior, resolving Interior symptoms. If Exterior fever with Interior Jue, persistent diarrhea, and restlessness, fever indicates Yang scattering on Exterior, hence fatal.