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[Commentary by Xiu] The heat pathogen transmitted through the meridians, once it enters the Shaoyin (Lesser Yin) meridian, first injures the yin fluids within the meridian. Often, the pathogen is not yet eliminated while the yin is already exhausted; thus, many die and few survive. How much more so when complicated by syndromes of other meridians—can such a person still have vitality? However, during differentiation, there are two key principles. First, differentiate whether the person's true yang has been deficient since constitution. If yin-cold is the root, the pathogen often moves with water-dampness. Symptoms include vomiting, coughing, profuse sweating like pearls (Pohan), abdominal pain, and diarrhea. This indicates Shaoyin yin excess and deficiency of Stomach yang. The treatment method should be to tonify fire and cultivate earth to control water, which goes without saying. Even if these symptoms appear in Taiyang disease, early addition of dried ginger (Ganjiang) and prepared aconite (Fuzi) to the exterior-releasing formulas is necessary to assist yang and resist yin, thereby avoiding the danger of forced sweating leading to collapse of yang. Second, differentiate whether the person's true yin has been deficient since constitution. If yang hyperactivity is the root, the pathogen often moves with fire. Symptoms include dry mouth and throat, mental restlessness and insomnia, abdominal fullness, constipation, and dry skin. This indicates excessive Stomach yang and exhaustion of Shaoyin yin. The treatment method should urgently drain earth (Spleen/Stomach) to save Kidney water. If attacking yang is not suitable, one should nourish yin and retreat yang. Even in Taiyang exterior-releasing formulas, early addition of donkey-hide gelatin (Ejiao) and rehmannia root (Shengdi) is needed to protect the true yin, so that sweating can occur to resolve the exterior. Otherwise, if yin essence is robbed, there will be no source for sweat, and pure exterior-releasing drugs will fail to produce sweat for this reason.

Biao (Mark/Manifestation) syndromes of Jueyin (Terminal Yin): Cold hands and feet, general spasm of tendons, alternating chills and fever resembling malaria, headache with salivation, blue complexion and red eyes, deafness, swollen cheeks, chest fullness and reverse flow of qi (vomiting), or even testicular hernia pain in men, and lower abdominal swelling and pain in women.

[Commentary by Xiu] Whenever yin and yang qi do not connect smoothly, it is called "Jue" (Cold Extremities). Jue refers to cold hands and feet. There is cold Jue and hot Jue. In Jueyin, hot Jue is common and cold Jue is rare; in Shaoyin, cold Jue is common and hot Jue is rare. Jueyin and Shaoyang are interior-exteriorly related. The alternation of Jue and heat in Jueyin is similar to the alternation of chills and fever in Shaoyang. The chills in Shaoyang are caused by heat; the Jue in Jueyin is also caused by heat. Heat is a yang pathogen moving outward; Jue is a yang pathogen sinking inward. Both Jue and heat belong to yang pathogens entering and exiting the yin divisions. When heat is abundant and Jue is scarce, and heat exceeds Jue, the injury to yin is relatively slow. When Jue is abundant and heat is scarce, and Jue exceeds heat, the injury to yin is more urgent. Therefore, the deeper the Jue, the deeper the heat; the milder the Jue, the milder the heat. In summary, Jueyin focuses on Jue and heat as the key indicators. Whenever there is Jue accompanied by heat, the Jue is definitely hot Jue. Combined with slippery pulse and sore throat with pus/blood in stool, or deep-short pulse and retracted scrotum, or deep-rapid pulse and cyanotic nails, or constipation with abdominal fullness, hardness, and pain, among other manifestations of Jue, applying Si Ni San (Frigid Extremities Powder) and comparing it with Bai Hu Tang (White Tiger Decoction) and Cheng Qi Tang (Order the Qi Decoctions) allows one to determine it is hot Jue. Only when there is Jue without heat, or even a single episode of Jue without subsequent heat, or massive sweating and severe diarrhea with Jue and aversion to cold, or vomiting with clear urination and body without heat but with Jue, is this truly cold Jue. At this point, Dang Gui Si Ni Tang (Tangkuei Decoction for Frigid Extremities) can be used to warm the meridians. For Zang Jue (Viscera Jue) with salivation, Wu Zhu Yu Tang (Evodia Decoction) is used. For Hui Jue (Roundworm Jue) with expulsion of roundworms, Wu Mei Wan (Mume Pill) is used. All follow this principle.

Ben (Root/Essence) syndromes of Jueyin: Thirst requiring water intake, sensation of qi rushing up to the heart, painful heat in the epigastrium, hunger without desire to eat, expulsion of roundworms after eating, dysentery with a feeling of heaviness in the anus. Misapplication of purgatives leads to unceasing diarrhea, or pus and blood in stool, or even syncope resembling death, twitching of hands and feet, body coldness with absent pulse, curled tongue, and retracted scrotum. In women, breast retraction and pulsating Chong and Ren vessels felt under the hand.

[Commentary by Xiu] The Jueyin meridian features the most complex mixtures of cold and heat, and ambiguous yin-yang presentations. One must clearly distinguish boundaries to find a thread. For example, heat with Jue, where deep heat causes deep Jue, attacking upward causing sore throat, or attacking downward causing pus and blood in stool, is a syndrome of pure yang without yin. Pulse is faint and thin, nearly imperceptible; hands and feet are cold; warming with moxibustion does not restore warmth; shivering aversion to cold; massive sweating and severe diarrhea; restlessness unable to lie down; and cold accumulation at Guanyuan point—all indicate pure yin without yang. Desire to drink water, hunger with desire to eat, slippery and rapid pulse, and naturally warm hands and feet indicate yang advancing and the condition about to heal. Silent demeanor, lack of appetite, vomiting of saliva/phlegm, abdominal distension, and body ache indicate yin advancing and the condition not healing. Three days of Jue corresponds to three days of heat; five days of Jue corresponds to five days of heat. With cold hands and feet, but pathogenic heat in the diaphragm and water-heat in the stomach, this is less yin and more yang. Diarrhea with undigested food, interior cold with exterior heat, vomiting with weak pulse, originally cold below, further mistreated with vomiting and purging, with facial flushing (floating yang), this is more yin and less yang. Generally, yang pulses and yang syndromes should be treated using Shaoyang and Yangming methods. Yin pulses and yin syndromes should use Shaoyin methods. Jueyin disease presenting with yang signs is easier to cure; presenting with yin signs is difficult to cure. When interior and exterior are mixed and indistinct, one must first treat the interior, then release the exterior. If there is throat obstruction, coughing up pus and blood, warm drugs must be strictly avoided; instead, one should resolve heat and clear/nourish dryness. I have seen cases where the whole body was ice cold, yet the patient wore no clothes and refused blankets; patients ordered to be fanned by two people; patients desiring to drink ice water freely. Is this not latent fire inside, extreme heat causing aversion to heat? The Liver stores blood and contains many collaterals. When pathogenic heat enters the collaterals, blood stagnates and transforms into fire, and qi becomes sluggish and dull. Thus, Jueyin disease focuses on blood heat and collateral stagnation. Observing Si Ni San for hot Jue and Dang Gui Si Ni Tang for cold Jue, both using pungent-moistening methods to unblock collaterals as the chief action, shows that rigid-drying drugs are inappropriate. It also shows that ginger and aconite in the Jueyin chapter are specifically set for concurrent Shaoyin deficiency-cold. Cases of Shaoyin disease suitable for clearing and nourishing belong to Jueyin; cases of Jueyin disease suitable for warming and heating belong to Shaoyin. Jueyin wind transformation internally houses Shaoyang ministerial fire, while Shaoyin, though belonging to sovereign fire, actually governs Taiyang cold-water.

Zhong (Middle/Intermediate) syndromes of Jueyin: Dizziness and blurred vision, bitter taste and deafness, alternating chills and fever. Chills cause cold extremities; heat causes dry retching and thirst for drinks, vomiting yellow-green water, or black foul-smelling turbid yin fluids, or expelling roundworms, even leading to roundworm Jue. Pain radiating through the hypochondrium, spasms or Jue.

[Commentary by Xiu] Among the six meridians, Jueyin is the most difficult to regulate. Jueyin internally harbors ministerial fire and essentially possesses heat without cold. Even if directly affected by cold pathogen, presenting with cold extremities and fine pulse, Zhang Zhongjing uses only Dang Gui Si Ni Tang and avoids ginger and aconite, from which we can understand. So why do Gui Zhi, Fu Zi, Xin Yi, and Gan Jiang all appear in Wu Mei Wan? Because Jueyin fire stagnation must invade Yangming. If Yangming qi is substantial, liver fire disperses freely through Shaoyang. If Stomach yang cannot support, wood pathogen attacks earth, collapsing Yangming closure and opening Taiyin, resulting in simultaneous vomiting and diarrhea, with fear of yang collapse. Therefore, heavy use of spleen-warming methods is required to align with Yangming substance and avoid Taiyin deficiency. This is the method of turning absolute yin into generating yang, using generating yang to break absolute yin. Otherwise, sour and bitter flavors, while having the strength to clear and drain Jueyin, would inevitably harm stomach qi and damage yang. In summary, Jueyin syndromes rely entirely on Stomach yang as the vital spirit. If Stomach yang prevails, the disease turns to Shaoyang and recedes; if Stomach yang fails, it turns to Taiyin and progresses. Stomach yin serves as the rear guard. If Stomach yin prevails, it controls ministerial fire and allows pathogenic heat to exit externally; if Stomach yin declines, it exhausts Kidney water and causes deficient yang to float upward. Observing Zhang Zhongjing using Li Zhong Tang for cholera and Mai Mai Wen Jing Tang (or Fu Mai Tang) for yin exhaustion reveals his main intent clearly. Zhao Yangkui and Gao Gufeng previously used Xiao Yao San plus Sheng Di, and Shu Gan Yi Shen Tang, to treat typhoid transforming into fire and consuming yin, coincidentally matching Zhang Zhongjing's correct method for Jueyin disease. Later, Ye Tianshi traced back to Fu Mai Tang and Huang Lian E Jiao Tang. The methods of former sages share the same principle.

Jian (Concurrent) syndromes of Jueyin: Concurrent Lung meridian syndrome: Cough with sticky phlegm, chest pain radiating to hypochondrium, even hemoptysis, or blood-streaked sputum. Concurrent Heart meridian syndrome: Curled, scorched, short tongue, beaked mouth, unconsciousness, snoring while awake, grasping at empty air, eyes rolling up, blue face and purple eyes. Concurrent Spleen meridian syndrome: Epigastric fullness with vomiting, abdominal pain with spontaneous diarrhea, cold extremities, thirst without desire to drink, sallow complexion, mental fatigue. Concurrent Stomach meridian syndrome: Chest and epigastric fullness, food rejection, drawing pain in hypochondrium, stomach pain with acid regurgitation, hunger without desire to eat, gastric discomfort. Concurrent Kidney meridian syndrome: Haggard complexion, tender red malar flush, panting and shortness of breath, disconnected qi, cold hands and feet, soreness and weakness of waist and knees, cold feet and seminal emission in men, profuse leukorrhea in women.

[Commentary by Xiu] Six-meridian infectious syndromes concurrent with Jueyin can still be treated. However, if transmitted from the Three Yang meridians to Jueyin, penetrating deeply into the interior, wind-wood and ministerial fire fan each other, injuring yin rapidly. Consumption of yin fluids allows pathogenic heat to sink into the Pericardium, causing delirium and unconsciousness, or mutism resembling death; sinking into Liver collaterals causes cold extremities, even spasms of hands and feet. Extreme heat generates wind, closing the nine orifices, forming defeat syndromes. Thus, Jueyin has the most fatal syndromes. Only concurrent Lung and Stomach meridians, if treated correctly, can turn danger into safety. Concurrent Heart, Spleen, and Kidney meridians result in many deaths and few survivals.

[Commentary by Lian] For all infectious syndromes transmitting to Jueyin, differentiate Hand and Foot meridians. Hand Jueyin is the Pericardium, governing blood and vessels, spreading horizontally. Symptoms like thirst, qi rushing to heart, painful heat in epigastrium arise from Pericardium carrying Heart fire heat activating upward, potentially leading to Jue and mutism resembling death due to sticky phlegm and stasis blocking the clear orifices of Heart and Brain. Treatment should prioritize clearing phlegm and removing stasis, unblocking collaterals and opening orifices, supplemented by dissipating fire and venting heat. Foot Jueyin is the Liver, storing blood and returning blood, qi transformation belongs to wind, containing Gallbladder fire. Alternating chills and fever represent Jue-heat alternation; exterior cold interior heat represents deep Jue meaning deep heat; lower cold upper heat represents hunger without desire to eat and expelling roundworms; yin surging and yang returning represents convulsions rotating left and right; yang returning and yin recovering represents balanced Jue and heat leading to self-healing. Regarding worms generated by wind, dampness must accumulate first; thus worms transform via wind and dampness. Syndromes are mostly mixed cold and heat. Treatment should prioritize bitter descending, pungent unblocking, and sour draining, possibly assisting with extinguishing wind or preserving yin.

[Commentary by Rongzhai] The items in this section analyze Ben, Biao, Zhong, and Jian syndromes of the six meridians in detail, bordering on complexity. Mr. Lu Yuanlei, in *Shanghan Jinshi* (Modern Interpretation of Treatise on Cold Damage), pointed out the method of mastering simplicity to control complexity, stating: "Fever with aversion to cold, regardless of sweating, is Taiyang disease; alternating chills and fever like malaria is Shaoyang disease; fever with sweating, no aversion to cold but aversion to heat is Yangming disease; symptoms of functional decline or deficiency of righteous qi due to mis-treatment is Shaoyin disease; vomiting and diarrhea belonging to deficiency-cold is Taiyin disease; fever for several days followed by absence of fever for several days, or thirst, or expelling roundworms, or diarrhea, or curled tongue and retracted scrotum is Jueyin disease." This is refreshingly clear. In *Shanghan Lun Gaoyao* (Outline of Treatise on Cold Damage), he more concisely stated: "The Three Yang are the standard types of febrile diseases; based on the trend of resistance, they are divided into three complex syndromes treated with three methods; Shaoyin is the variant type of febrile disease, with cardiac weakness, unable to generate resistance, life in peril, requiring urgent cardiotonics; Taiyin is miscellaneous disease, not cold damage; Jueyin is scattered." Mr. Lu's view on the six-meridian syndromes in *Shanghan Lun* is precise and profound; his indication serves as practice for our research to "return from extensive to simple." Broadly speaking, "Six-Meridian Syndromes" divide the course of acute febrile diseases into six stages. Each stage is subdivided into several sub-types based on different symptoms, each containing several similar but slightly different complex syndromes; this evolves the Ben, Biao, Zhong, and Jian syndromes of the six meridians. For this text, we should grasp its spirit, but need not be rigid about its details.