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Difficulty 60 states: Regarding diseases of the head and heart, there are Jue pain (Jue Tong) and Zhen pain (Zhen Tong). What does this mean?

The response is: When the meridians of the Hand Three Yang (Hand Taiyang, Hand Yangming, Hand Shaoyang) are affected by Wind-Cold, and the pathogenic factor lingers and remains without dissipating, it is named Jue Headache.

"Jue" means reversal or counterflow, referring to pain caused by Qi counterflow. Jue pain includes Jue Headache and Jue Heartache. Zhen pain includes Zhen Headache and Zhen Heartache. When the meridians of the Hand Three Yang are stagnated by Wind-Cold, causing Qi to become obstructed and reverse, rushing upwards to the head, it is therefore called Jue Headache. If the meridians of the Foot Three Yang (Foot Taiyang, Foot Yangming, Foot Shaoyang) are also stagnated by Wind-Cold, they too can cause headaches; the reason this is not mentioned here is due to textual omission (as the principle is similar).

If the pathogen penetrates deeply and connects with the brain, it is named Zhen Headache.

Zhen Headache does not reside in the meridians but penetrates into the brain; therefore, the pain is severe, involving the entire brain, accompanied by coldness of the hands and feet extending to the joints. This condition is fatal and untreatable. This is because the brain is the Sea of Marrow, the gathering place of True Qi. It cannot suddenly withstand pathogens; once invaded, death ensues.

Commentary: In *Su Wen: Chapter on Rare Diseases*, the Yellow Emperor asks: "There are people suffering from headache that persists for years. How did they acquire it, and what is the name of this disease?" Qibo replies: "This must be due to exposure to severe Cold, which penetrated inward to the bone marrow. Since the brain is the master of marrow, the Cold causes Qi to reverse upward to the brain, resulting in headache and toothache. This disease is named Jue Ni (Counterflow Reversal)." This occurs because Cold pathogen enters the marrow, ascending to the head and brain to cause pain. Since the pathogen is deep-seated, the condition persists for years. For example, as recorded in *Ling Shu: Chapter on Jue Diseases*, if Jue Headache presents with facial swelling and irritability, it is caused by the counterflow of Yangming Qi. If there is pain along the temporal vessels, sadness, and a tendency to weep, it is caused by the counterflow of Jueyin Qi. If there is a heavy sensation and pain in the head, it is caused by the counterflow of Shaoyin Qi. If neck pain precedes, followed by corresponding pain in the lower back and spine, it is caused by the counterflow of Taiyang Qi. If the headache is severe, with pulsating vessels around the ears and heat, it is caused by the counterflow of Shaoyang Qi. As for Zhen Headache, the headache is severe, the entire brain hurts, and the hands and feet are cold up to the joints, leading to death and being untreatable. These cases are not due to the counterflow of the Six Qi, but rather an external pathogen invading the brain, hence the severe headache and whole-brain pain. The head is the summit of all Yang meridians, and the brain is the sea of Essence and Water. When the hands and feet are cold up to the joints, it indicates that True Qi has been damaged by the pathogen, making it fatal and untreatable. Furthermore, there are pains caused by blows or falls, by severe Bi syndrome, or by Cold damaging Ying Blood causing unilateral pain. These are the various causes of headache discussed in the classics, not limited to diseases of the Hand Three Yang meridians.

When the Qi of the Five Zang organs interferes with each other, it is named Jue Heartache.

All meridians connect to the Heart. The Heart governs all blood vessels, and Ying Blood flows from the Heart through the Twelve Meridians. If a disease occurs in any one meridian, its Qi may reverse. Reversed Qi will attack the Heart; attacking the Heart results in Heartache, hence it is called Jue Heartache. This is pain caused by the counterflow of Qi from the Five Zang organs, not a primary disease of the Heart itself.

If the pain is extremely severe, localized solely in the Heart region, and the hands and feet turn cyanotic (blue/green), it is named Zhen Heartache. Patients with Zhen Heartache who develop symptoms in the morning will die by evening, and those who develop symptoms in the evening will die by morning.

The Heart is the great master of the Zang-Fu organs and the residence of Spirit (Shen). Its organ structure is solid, and pathogens cannot easily invade. If pathogens do invade, they damage the Heart; if the Heart is damaged, the Spirit departs; if the Spirit departs, death occurs. Zhen Heartache involves severe pain localized only in the Heart without interference from other Zang organs. The cyanosis of the hands and feet occurs because Cold pathogen invades the position of Ministerial Fire (Jun Huo), altering the color of the blood. The mortality pattern (morning onset/evening death, or vice versa) reflects the fact that the Heart generally does not accept pathogens in this manner; similarly, the Brain does not accept pathogens. Therefore, Master Hua (Huashi) suggested that the character 'Zhen' (True) in Zhen Heartache should ideally have a 'Head' (Tou) component below it, implying that Zhen Heartache and Zhen Headache share the same critical nature of direct invasion of the vital essence.

Commentary: *Ling Shu: Chapter on Jue Diseases* states: "Jue Heartache that radiates to the back, accompanied by spasms, feeling as if touched from behind, with the patient stooping, is Kidney Heartache." "Abdominal distension, chest fullness, and particularly severe Heartache is Stomach Heartache." "Heartache feeling like being pierced by an awl or needle, with severe pain, is Spleen Heartache." "Pale, ashen complexion resembling death, unable to take a deep sigh all day, is Liver Heartache." "Heartache that alleviates when lying down or resting at home, but worsens with movement, with unchanged complexion, is Lung Heartache." These differentiate pains caused by the interference of various Zang organs. Additionally, Zhen Heartache presents with cyanosis of the hands and feet extending to the joints, severe Heartache, and early death (morning onset/evening death, or evening onset/morning death). This indicates damage to the True Essence of the Zang organs, constituting Zhen Heartache.