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Lou Quanshan said: Wang Bing (Wang Taipu) stated: Jue (Jue syndrome, characterized by cold or hot extremities due to Qi counterflow) is Qi counterflowing upward. The world erroneously transmits it as "Hong Kong Foot" (a disease primarily characterized by swelling and pain in the feet), but reading this text reveals that this disease was called "Hong Kong Foot" in ancient times. The Classics state: Cold Jue presents with cold hands and feet; Hot Jue presents with hot hands and feet; Wei Jue (Atrophic Jue) is a combination of Atrophy syndrome and Jue syndrome, resulting in weak and powerless legs; Bi Jue (Obstruction Jue) is a combination of Obstruction syndrome and Jue syndrome, presenting as stubborn numbness, swelling, and pain in the feet; Jue Ni (Counterflow Jue) refers to the aforementioned Cold Jue, Hot Jue, Wei Jue, Bi Jue, Feng Jue (Wind Jue), etc., where Qi counterflows upward, accompanied by vomiting, mental confusion, abdominal distension or shortness of breath, insensitivity of the lower abdomen, or sudden unconsciousness. This is what the world calls "Hong Kong Foot rushing to the heart." Nowadays, people also refer to sudden fainting and loss of consciousness as Jue. Someone asked: The world names hand and foot coldness as Jue, how is this? I replied: Incorrect. In Zhang Zhongjing's discussion on Shanghan (Cold Damage), he termed hand and foot heat as Hot Jue, and hand and foot coldness as Cold Jue, with coldness specifically called "Ni" (counterflow). He stated that any Jue syndrome occurs when Yin and Yang Qi fail to connect smoothly, and the manifestation of Jue is cold extremities. Therefore, for those with Yang deficiency failing to connect, warming methods are used; for those with Yang sinking and lying deep, unable to connect with Yin, purgative methods are used; for those with pathogenic heat entering but not yet deep, the heat transmitting to the Yin meridians is dispersed, and treatment is administered according to the depth and severity of the condition. This specifically refers to Shanghan pathogenic factors moving from the exterior to the interior, reaching the Taiyin stage with cold extremities, attributing it solely to these two meridians. Since this discussion is based on the transmission of pathogens through the Six Meridians of Shanghan, the Jueyin meridian is described as the convergence of two Yins. When heat transmits to this point, it is at its deepest, hence named Jueyin. However, the meaning in the *Neijing* chapter on Jue is different. It generally states that the Three Yang meridians of the foot originate from the lateral side of the five toes, and the Three Yin meridians originate from the medial side. Thus, when Yang Qi prevails, the sole of the foot becomes hot; when Yin Qi prevails, coldness extends from the toes to above the knee. Discussing the cause of Cold Jue, it says: The anterior yin is the gathering place of the Zongjin (tendons), and the meeting point of the Taiyin (Spleen) and Yangming (Stomach) meridians. For a person of robust constitution, during autumn and winter when Yin Qi is abundant and Yang Qi is declining, excessive exertion depletes the lower Qi, causing it to contend upward without recovery, essence spills out, and pathogenic factors follow upward. Yang Qi declines and cannot moisten and nourish the collaterals, leading to daily depletion of Yang Qi and predominance of Yin Qi, thus causing coldness in the hands and feet. Discussing the cause of Hot Jue, it says: A person must frequently drink alcohol or engage in sexual activity after full meals, causing Qi to accumulate in the Spleen, weakening Kidney Qi, leading to predominant Yang Qi, thus causing heat in the hands and feet. Observing its subtle implications, it likely aims to illustrate that the Kidney receives the pre-heavenly essence, from which Yuan Qi is filled. The two Zang organs (Kidney and Spleen/Stomach) interact, allowing the pulse channels to function, transporting Yin and Yang inside and outside, each having its duties. Yang governs the exterior and provides warmth; Yin governs the interior and provides coldness. The exterior and interior pulse channels circulate and connect at the four limbs. Therefore, taking the example of Spleen and Stomach damage due to alcohol and lust, leading to major Yin-Yang Jue syndromes, placed at the beginning of the chapter, followed by the narration of Jue Ni of the Twelve Meridians, only listing the manifestations of Qi counterflow in the respective meridians, without mentioning hand/foot Jue or the causes of disease, as one sentence cannot suffice. Since two examples are set beforehand, inference can be made here, so no further words are needed. Nevertheless, let us detail other chapters regarding Jue to clarify them. As stated in the *Taiyin Yangming Lun*: Yangming (Stomach) is where the Five Zang and Six Fu organs receive Qi. Now, if the Spleen is diseased and cannot transport fluids to the Three Yin meridians along with the Stomach, and the Stomach cannot transport fluids to the Three Yang meridians, the four limbs do not receive water and grain Qi, becoming increasingly deficient day by day. The Yin channels become obstructed, and bones, sinews, muscles lack Qi for generation. From this perspective, Spleen and Stomach have excess and deficiency, alternating in dominance. The deficient cannot transport fluids, while the excess acts alone; acting alone leads to coldness. This is the first way Spleen and Stomach cause Jue. Furthermore, all twelve meridians receive Qi from the Stomach. Receiving Stomach cold makes meridian Qi cold; receiving Stomach heat makes meridian Qi hot. Consequently, meridian Qi becomes disordered, and during circulation and connection, cold and heat are inevitably left in the four extremities. This is the second way Spleen and Stomach cause Jue. Additionally, Spleen and Stomach are the controlling organs of the Kidney. If Spleen and Stomach have pathogens, they must attack the Kidney. The Kidney resides in the lower jiao and governs Jue. If the Kidney is affected by pathogens, Jue occurs. This is the third way Spleen and Stomach cause Jue. The *Lingshu* states: The Chong Mai (Penetrating Vessel) emerges from the Kidney together with the great Luo vessel of Shaoyin, serving as the Sea of the Five Zang and Six Fu organs, so all organs receive from it. Its upper branch seeps into the Yang meridians and irrigates essence; its lower branch joins the Shaoyin channel, seeps into the Three Yin meridians, irrigates the collaterals, and warms the muscles. If its collateral branches knot, the dorsum of the foot becomes immobile; immobility leads to Jue, and Jue leads to coldness. The Chong Mai conducts the Yang Qi governing the interior of the Kidney. Yang is Fire. When Yang moves correctly, it is the mild fire that generates and warms life; when it moves recklessly, it is the fierce fire that damages things. Fierce fire causes the original true Yang to decline. Li Dongyuan said that Fire and Yuan Qi cannot coexist; when one wins, the other loses. As mentioned in the previous Jue Lun, lower Qi contending upward and pathogenic factors following upward is not another pathogen, but this Fire causing chaos, with chaotic Yin and Yang Qi rising and counterflowing. Hence, the Classics attribute counterflow Qi to the Chong Mai disease, and the Pathogenesis principles state that all counterflowing upward symptoms belong to Fire; all Jue symptoms belong to the Lower Jiao. However, when Kidney Yin and Yang are harmonious, the Lower Jiao is governed well; when unharmonious, it is not governed well, leading to Cold or Hot Jue. This is the way the Kidney governs Jue. Regarding the Chong Mai and Stomach, both named "Sea," the twelve meridians receiving Qi result in identical Jue diseases. Other chapters discuss Jue caused by Yang Qi overexertion leading to expansion, essence exhaustion accumulating in summer, causing Jian Jue (Frying Jue); or Er Yang (Stomach/Large Intestine) and Yi Yin (Liver) pathology causing Feng Jue; or insufficient Zhi (Will) causing Jue; or Zang Jue; or sudden unconsciousness Jue; or Shi Jue (Corpse Jue) due to exhaustion of five collaterals. All these counterflowing pathogens are stirred up by Xiang Huo (Ministerial Fire) interacting with the Five Fires. Once stirred, they disrupt meridian Qi, causing the Five Qi (Wind, Cold, Dryness, Dampness, Heat) to arise. These Five Qi often transform together: Wind and Dryness transform with Heat, Dampness transforms with Cold. Severe cases result in extremity meridians undergoing Jue according to the transformed Cold or Heat. Presumably, Qi counterflowing from below to above requires the momentum of Fire. Sanjiao, Foot Shaoyang Gallbladder, Chong, Ren, and Du meridians all govern Ministerial Fire in the lower body, yet are unified under the Kidney. Why? Because Foot Shaoyin Kidney (Zi) and Hand Shaoyin Heart (Wu) correspond and transform, residing therein, allowing Kidney Yuan Qi to govern the lower body properly. If Ministerial Fire moves recklessly, one must first rescue the Kidney, distinguishing direct and indirect treatments, checking the counterflow, and identifying the prevalence of the Five Qi for tonification or sedation. Although there are cases of sudden coldness not due to Qi counterflow, such as in *Yuan Bing Shi*, which states that Yin Water governs tranquility, so cold illness causes cold limbs. This is due to Yang deficiency with Yin predominance causing cold, i.e., Zhongjing's concept of initial Jue followed by heat, where external Cold pathogens overwhelm Yang, causing initial Jue. Although pathogens have internal and external distinctions, warming treatment remains the same.

[Cold and Hot Jue] *Suwen*: Huangdi asked: What is the mechanism behind cold and hot Jue? Qibo answered: Yang Qi deficiency in the lower part causes Cold Jue; Yin Qi deficiency in the lower part causes Hot Jue. Di asked: Why does Hot Jue heat always start from the soles of the feet? 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 heel. Thus, when Yang Qi prevails, the sole becomes hot. Di asked: Why does Cold Jue coldness always rise from the five toes to the knees? Qibo said: Yin Qi originates from the medial aspect of the five toes, gathers below the knee, and converges above the knee. Thus, when Yin Qi prevails, coldness spreads from the toes to above the knee. This coldness does not come from the exterior but arises from within. Di asked: How does Cold Jue occur? Qibo said: The anterior yin is the gathering place of the Zongjin, the meeting point of Taiyin and Yangming. In spring and summer, Yang Qi is abundant and Yin Qi is scarce; in autumn and winter, Yin Qi is abundant and Yang Qi is scarce. A robust person who overexerts themselves during autumn and winter causes lower Qi to contend upward without recovery, essence spills out, and pathogenic factors follow upward. Qi stagnates in the middle, Yang Qi declines and cannot moisten the meridians, Yang Qi diminishes daily, Yin Qi remains alone, causing cold hands and feet. Di asked: How does Hot Jue occur? Qibo said: Alcohol enters the stomach, filling the Luo vessels while emptying the Jing meridians. The Spleen transports fluids for the Stomach. When Yin Qi is deficient, Yang Qi enters; when Yang Qi enters, the Stomach becomes disharmonious; when the Stomach is disharmonious, essence is exhausted; when essence is exhausted, the four limbs are not nourished. Such persons often drink heavily or engage in sex after full meals, causing Qi to accumulate in the Spleen without dispersing. Alcohol Qi and Grain Qi struggle, generating intense heat in the center, spreading heat throughout the body, causing internal heat and red urine. Alcohol Qi is strong and pungent, daily depleting Kidney Qi, leading to predominant Yang Qi, causing hot hands and feet. The *Lingshu·Dian Kuang* chapter states that Jue Ni presents with sudden cold feet, chest feeling like splitting, intestines feeling like being cut by a knife, irritability, inability to eat, and choppy pulses of all sizes. Warmth should be applied to Foot Shaoyin points, coolness to Foot Yangming points. Cold conditions require tonification, heat conditions require sedation. *Rumen Shiqin* states: Li Zhengzhi from Xihua suffered from Cold Jue, and his wife from Hot Jue, for over ten years. His wife took Xiaoyao San for over ten doses with no effect. One day, I diagnosed them; both had floating, large, and forceless pulses. Zhengzhi said: "My hands and feet are cold, soaking in hot water doesn't stop it; my wife's hands and feet are hot, pouring cold water doesn't stop it. Why?" I said: "This is Cold and Hot Jue. Both resulted from gluttony and indulgence in desires." I cited the *Neijing·Jue Lun* to verify. Zhengzhi joyfully said: "Ten years of doubt is now resolved. Even without medicine, I am half cured." I said: "Hot Jue has cold in the Upper Jiao; Cold Jue has heat in the Upper Jiao. For cold in the Upper Jiao, use warm agents to tonify Lung Metal. For heat in the Upper Jiao, use cool agents to clear Heart Fire. Take these two medicines continuously. Within ten days, Zhengzhi thanked me, saying both Cold and Hot Jue were cured." *Yuan Bing Shi* states that Jue has Yin and Yang distinctions. Yin Jue presents with Yin signs: cool body, no thirst, slow, fine, and minute pulse. Yang Jue presents with Yang signs: irritability, thirst, delirium, fever, and rapid pulse. If Yang Jue is extreme or untreated, leading to cold body and Yin signs with a faint, nearly imperceptible pulse leading to death, this is due to extreme heat. Wang Andao said: Extreme heat causing Jue is Yang extreme resembling Yin; extreme cold causing Jue is pure Yin without Yang. Yang extreme resembling Yin uses cold herbs; pure Yin without Yang uses hot herbs. This must be distinguished. Ye Shi said: The Cold and Hot Jue in *Neijing* refers to Yin and Yang Qi counterflow causing deficiency syndromes. Cold Jue tonifies Yang; Hot Jue tonifies Yin. This aligns with Wang Taipu's statement: "Strengthen the master of Water to suppress excessive Yang; benefit the source of Fire to eliminate Yin shadows." This tonifies the deficiency of True Water and True Fire. Zhongjing, Hejian, and Andao discussed Jue as cold extremities due to Shanghan. Since the syndromes differ, treatments differ. Cold Jue: Exterior heat, interior cold, diarrhea with undigested food, vomiting immediately after eating, deep and hidden pulse, cold extremities; treated with Sini Tang. Hot Jue: Abdominal fullness, heaviness, difficulty turning, greasy face, delirium, urinary incontinence, cold extremities with spontaneous sweating, deep and slippery pulse; treated with Baihu Tang. Hot Jue with hot extremities and wandering redness: Shengyang Xiehuo Tang. If stool is hard: Dachaihu Tang. Cold Jue with cold extremities: Fuzi Lizhong Tang. Cold fingertips (Qing): Lizhong Tang.

[Cold Jue with Cold Extremities] Deep, rapid, and full pulse indicates Heat. Li Dongyuan treated Zhongshu Tiehe Gong with coldness in feet, knees, buttocks, waist, and back, with a deep, rapid, and forceful pulse, using Huangbai Zishen Wan, cured after two doses. He also treated Zhongshu Zuocheng Yao Gongmao with upper heat and lower cold, cured with Jiji Jiedu Tang. Danxi treated Lv Zongxin with abdominal masses and cold feet up to the knees, cured with modified Dachengqi Tang. These are Cold Jue with Heat. Deep, fine, and minute pulse indicates Cold. Luo Qianfu treated Zhengnan Fuyuanshuai Datemu'er, aged 60, who campaigned in July and fell ill in mid-winter with spontaneous diarrhea of undigested food, cold pain in the umbilical and abdominal region, cold shanks, insensitivity to scratching, requiring heated stones for warmth without relief. Pulse was deep, fine, and minute. This was due to advanced age, weak Qi, deep penetration into enemy territory, complex military duties, morning and evening exposure to cold, irregular diet, excessive consumption of milk and cheese, living in damp lowlands, Yang failing to secure the exterior, allowing cold-dampness to invade deficiency, causing disease from below, hence cold and counterflow in the shanks. *Neijing* states: Contracting cold causes disease; mild cases cause cough, severe cases cause diarrhea and pain. This is cold-dampness combining to cause disease. Treatment should urgently dispel cold-dampness and strongly tonify Yang; only moxibustion can cure. First, moxa Qihai with large cones, 100 moxa units, to tonify Lower Jiao Yang deficiency. Second, moxiate Zusanli 21 units each, treating cold and counterflow in shanks, guiding Yang Qi downward. Third, moxiate Sanyinjiao to dispel cold-dampness in the feet. Prescription: For overwhelming cold, treat with acrid-hot; for external dampness, level with bitter-hot, dissipate with bitter. Fuzi, greatly acrid-hot, assists Yang, retreats Yin, warms meridians, and disperses cold as Sovereign herb. Ganjiang and Guizhi, greatly hot, acrid-sweet, also dispel cold-dampness; Baizhu and Banxia, bitter-acid-warm, dry Spleen dampness, as Ministers. Renshen, Caodoukou, and Gancao, greatly warm, tonify Middle and boost Qi; Shengjiang, greatly acrid-warm, dispels cold-dampness; Congbai, acrid-warm, unblocks Upper Jiao Yang Qi, as Assistants. Also: Tonifying lower and treating lower requires urgent preparation with strong flavor, hence large dosage. After a few doses, diarrhea stopped, pain reduced, shanks warmed, diet regulated, recovered in ten days. Next autumn, passing Xiangyang in rain, symptoms recurred after ten days. Re-moxa as before, adding Yangfu 14 units each, administering previous medicine, cured after a few doses. *Neijing* Cold Jue belongs to Kidney deficiency. Kidney governs Zhi (Will); insufficient Zhi causes Jue. Kidney deficiency causes Qing Jue and unhappiness. Lower deficiency causes Jue. All Jue, retention, and incontinence belong to the Lower Jiao. *Lingshu·Nishun Feishou*: Huangdi asked: Why does Shaoyin channel descend alone? Qibo said: No. Chong Mai is the Sea of Five Zang and Six Fu, receiving from all. Upper branch exits at Kangsang, seeps into Yang meridians, irrigates essence. Lower branch injects into Shaoyin's great Luo, exits at Qichong, follows inner thigh, enters yin, runs deep in bone, descends behind medial malleolus, then branches. Lower branch joins Shaoyin, seeps into Three Yin. Anterior branch runs deep, exits at Fusuo, follows dorsum, enters big toe, seeps into collaterals, warms muscles. If collateral knots, dorsum is immobile; immobile leads to Jue; Jue leads to cold. (Classics: Hard and tight meridians are treated with fire, i.e., moxibustion or herbal wine soak.) Yunqi Cold Jue has two types: One is Cold. Classics: Water qi is Jing Shun. Jing Shun cycle, disease is Jue. Year of excessive Water, cold qi spreads, evil harms Heart Fire, restlessness, palpitations, Yin Jue. Year of deficient Metal, flame fire acts, retaliation causes Yin Jue and obstruction. Two is Cold-Damp. Classics: Taiyin rules heaven, heaven qi descends, earth qi rises, people suffer Cold Jue. *Qianjin Fang* treats men with cold, immobile waist and feet: 3 dou good wine, 3 dou water, mix in urn, warm soak to knees, 3 days. Keep fire under urn to prevent cooling. Li Dongyuan: Classics say Jue in feet, Zong Qi does not descend, blood in meridians coagulates and stops; only fire can resolve it. Jiegu: Body hot as fire, feet cold as ice; moxa Yangfu. Leg acid-cold; moxa Jiegu.

[Hot Jue with Hot Extremities] Danxi said: Sicheng Shu always felt heat from ankles down since birth, could not add cotton in winter, claimed robust constitution不怕cold. I said: This is Foot Three Yin deficiency. Should abstain from sex, tonify and nourish Yin blood, perhaps avoidable. He laughed and refused. At 17, developed Wei syndrome, died in half a year. *Qianjin Fang* for hot hands and feet: 3 sheng urine, warm soak in basin. *Suwen* Hot Jue: Select Foot Taiyin and Shaoyang, retain needle.

Sudden unconsciousness Jue: Previously seen in Stroke/Jue Men. Here are mild cases not falling suddenly, not classified as stroke. Jue with phlegm tide, sawing sound in throat, is Phlegm Jue. First use Genti San, or Xixian San, or Ginseng Lu decoction to induce vomiting, then Daotan Tang with much Zhuli and little Jiangzhi. Sudden anger causing Qi counterflow and fainting is Qi Jue. Use Bawei Shunqi San, or Tiaoqi San, or Siqi Tang. Hand and foot spasms are Feng Jue. Use Xiao Xuming Tang. Alcohol-induced is Jiu Jue. Use Erchen Tang plus Gan Ge and Qing Pi, or Gehua Jieying Tang. Bone withering and claw pain is Gu Jue. Body straight as a rafter is Jue. Panting and distress is Yangming Jue. All due to Qi counterflow. Jue with abdominal fullness and unconsciousness, or recovering slightly after 1-2 days, all sudden confusion, due to pathogen chaos and Yang Qi counterflow, Shaoyin Kidney pulse absent. Kidney Qi weak, essence and blood rush, Qi急促, enters chest and hypochondrium, Zong Qi knots below heart, Yang Qi retreats, heat returns to thighs and abdomen, assisting Yin, causing insensitivity. Five collaterals meet at ears. Exhaustion of five collaterals causes whole body pulse movement but form insensible, like corpse, hence Shi Jue. Due to Zang Qi conflict or external pathogen clash, Qi stagnates, blocked in meridians, pulses hide, unconscious. Treat by opening Zang Qi: Cold with Heat, Heat with Cold, Blockage with Opening. Zhongjing: Shi Jue pulse moves but no Qi, Qi blocked, hence still and dead. Blow Schisandra powder into nostrils, place Cinnamon on tongue. Cut left corner hair square inch, burn to ash, mix with wine,灌, wake immediately. Blow air into ears with bamboo tube. Huanhun Tang. Sudden death, cold extremities, unconscious, abdominal Qi rumbling like thunder, is Shi Jue. Yanxiao 5 qian, Liuhuang 2 qian, grind fine, divide into 3 doses. Each dose decoct in 1 large cup good aged wine. When Yanxiao fumes rise, pour into basin, cover, warm drink. After walking 5 li, take next dose. Not more than 3 doses to wake. Moxa Baihui 49 units, Qihai and Dantian 300 units. Stop moxa when body warms. If no previous medicine, use 1 prepared black Fuzi, 1 liang Renshen, divide into 2 doses, decoct in 3 cups wine, or with Ginger juice and wine. Moxa Baihui, moxa cone size of mung bean, coarse hurts person.

[Diagnosis] Deep, minute, not rapid pulse is Cold Jue. Deep, hidden, rapid pulse is Hot Jue. Fine pulse is Qi deficiency. Large like scallion tube is Blood deficiency. Floating, rapid is Phlegm. String-taut, rapid is Heat. Floating is External Contraction. Pulse like panting is Qi Jue. Cun position deep, large, and slippery: Deep is Excess, Slippery is Qi,