素问·厥论 Discourse on Jue (Reversal) Syndrome

Huangdi asked: What is meant by cold and heat in jue, reversal? Qibo replied: When yang qi declines below, it becomes cold reversal; when yin qi declines below, it becomes heat reversal. Huangdi said: Why does the heat of heat reversal necessarily arise from beneath the feet? Qibo said: Yang qi arises from the outer aspect of the five toes; the yin vessels gather beneath the foot and collect in the sole of the foot; hence when yang qi predominates, the sole of the foot becomes hot. Huangdi said: Why does the cold of cold reversal necessarily proceed from the five toes upward to the knee? Qibo said: Yin qi arises from the inner aspect of the five toes, gathers below the knee, and collects above the knee; hence when yin qi predominates, cold extends from the five toes up to above the knee. This cold does not come from outside — it comes entirely from within. Huangdi said: What imbalance causes cold reversal to arise? Qibo said: The anterior yin is where the ancestral sinew gathers, and where the taiyin and yangming channels converge. In spring and summer, yang qi is abundant and yin qi is scant; in autumn and winter, yin qi is abundant and yang qi declines. When a person of robust constitution overexerts himself sexually during autumn and winter, the lower qi struggles to rise upward and cannot recover; essence qi overflows and drains downward, and pathogenic qi thereupon follows it and rises. Because the qi is drained from within, the yang qi declines and cannot seep through and nourish the channels and network vessels; the yang qi diminishes day by day, while the yin qi alone remains, and so the hands and feet become cold because of this. Huangdi said: How does heat reversal come about? Qibo said: When wine enters the stomach, the network vessels become full while the channel vessels become empty. The spleen governs the circulation of the fluids of the stomach; when yin qi is deficient, yang qi enters; when yang qi enters, the stomach becomes disharmonious; when the stomach is disharmonious, the essence qi is exhausted; when the essence qi is exhausted, it fails to nourish the four limbs. Such a person must frequently become intoxicated or enter the bedchamber after eating to excess; the qi collects in the spleen and cannot disperse, the qi of wine combines with the qi of grain, and heat becomes intense within; hence heat spreads throughout the body, with internal heat and reddish urine. Now the qi of wine is intense and fierce; the kidney qi weakens, and the yang qi alone prevails, so the hands and feet become hot because of this. Huangdi said: In jue, sometimes there is abdominal fullness, sometimes a sudden loss of consciousness, and sometimes the person does not regain consciousness for half a day or, at the longest, a full day — why is this? Qibo said: When yin qi is abundant above, there is deficiency below, and this deficiency below causes abdominal distension and fullness. When yang qi is abundant above, the lower qi doubles up and rises, and pathogenic qi moves in counterflow; this counterflow throws the yang qi into disorder, and when the yang qi is in disorder, the person loses consciousness.

Huangdi said: Good. I wish to hear of the forms and clinical manifestations of jue in the six channel vessels. Qibo said: In jue of the taiyang, the head swells and feels heavy, the feet cannot walk, and there is dizziness with collapse. In jue of the yangming, there is manic disease with a desire to run about and shout, abdominal fullness with inability to lie down, a red and feverish face, and seeing and speaking of delusions. In jue of the shaoyang, there is sudden deafness, swollen and hot cheeks, rib-side pain, and inability to move the shin. In jue of the taiyin, there is abdominal fullness and distension, difficulty with bowel movements, lack of appetite, vomiting upon eating, and inability to lie down. In jue of the shaoyin, there is dryness of the mouth, reddish urine, abdominal fullness, and heart pain. In jue of the jueyin, there is swelling and pain of the lower abdomen, abdominal distension, difficulty urinating and defecating, a preference for lying with the knees bent, retraction and swelling of the genitals, and internal heat of the shin. Where there is excess, drain it; where there is deficiency, supplement it; where there is neither excess nor deficiency, treat according to the affected channel. In taiyin jue reversal, the shin is tense and cramped, and heart pain pulls into the abdomen; treat the channel governing the disease. In shaoyin jue reversal, there is deficient fullness, vomiting and disturbance, and clear diarrhea below; treat the channel governing the disease. In jueyin jue reversal, there is cramping and lower back pain, deficient fullness, blockage of the front passage, and delirious speech; treat the channel governing the disease. When all three yin channels are in reversal together, there is inability to void urine or stool, the hands and feet become cold, and death occurs within three days. In taiyang jue reversal, there is stiffness and collapse, vomiting of blood, and frequent nosebleeds; treat the channel governing the disease. In shaoyang jue reversal, the joints do not move freely; when the joints do not move freely, the lower back cannot walk and the neck cannot turn to look back; if intestinal abscess develops, it cannot be treated, and if there is fright, the patient dies. In yangming jue reversal, there is panting and coughing, fever, frequent fright, nosebleed, and vomiting of blood. In hand taiyin jue reversal, there is deficient fullness with coughing and frequent vomiting of foam; treat the channel governing the disease. In hand jueyin, the heart master, and hand shaoyin jue reversal, there is heart pain pulling into the throat, with fever; this is fatal and cannot be treated. In hand taiyang jue reversal, there is deafness with tearing, the neck cannot turn to look back, and the lower back cannot bend forward or backward; treat the channel governing the disease. In hand yangming and hand shaoyang jue reversal, there is throat bi, obstruction, with swelling of the throat and stiffness; treat the channel governing the disease.