Diseases of the Zang organs involving the meridians: In a Shanghan (Cold Damage) condition, if after six or seven days, a severe purgation was administered, the pulse at the Cun position (inch) is deep and slow. There is cold reversal of the hands and feet, the pulse at the lower part (Chi position/cubit) cannot be felt, there is obstruction in the throat, vomiting of pus and blood, and incessant diarrhea. This is a difficult-to-treat condition, and Mahuang Shengma Tang (Ephedra and Cinnamon Twig Decoction) should be used.

(Mahuang Shengma Tang Syndrome)

Zang organ disease: The hallmark of Jueyin disease is excessive thirst, Qi rushing up to strike the heart, heat pain in the chest, hunger without desire to eat, and if food is ingested, expulsion of Ascaris (roundworms). If purged incorrectly, it leads to incessant diarrhea.

In Shanghan, with a faint pulse and cold reversal of the hands and feet, by the seventh or eighth day, the skin is cold, and the patient is restless with no moment of peace. This is Zang Jue (Organ Cold Reversal), not Ascaris Jue. Patients with Ascaris Jue typically vomit roundworms. The patient becomes quiet but occasionally experiences vexation because of cold in the Zang organs causing the Ascaris to move up into the diaphragm; this vexation ceases after a while. If the patient eats and vomits again with vexation, it is because the Ascaris smells the food and comes out; the patient will naturally vomit the Ascaris. Ascaris Jue is treated with Wumei Wan (Mume Pill).

When Yin and Yang qi fail to connect smoothly, Jue (Cold Reversal) occurs. Jue refers to cold reversal of the hands and feet. For all cases of Sini (Four-Chill/Cold Reversal) and Jue, downward purging must not be used; this also applies to patients with deficiency constitution.

In Shanghan, if Jue occurs from the first or second day to the fourth or fifth day, fever must be present. Fever precedes Jue; the deeper the Jue, the deeper the heat; the milder the Jue, the milder the heat. Such Jue should be treated with downward purging. If sweating is induced instead, it will inevitably cause injury and redness/ulceration of the mouth.

If Shanghan presents with five days of Jue and five days of fever, and on the sixth day Jue should recur but does not, the disease will resolve spontaneously. The duration of Jue does not exceed five days; since the fever lasted five days, we know it will heal.

In Shanghan, four days of Jue followed by only three days of fever, then Jue returns for five days; the disease must progress because cold exceeds heat, indicating the retreat of Yang Qi.

In Shanghan, four days of fever followed by only three days of Jue, then four more days of fever; since Jue is less and heat is more, the disease should heal. However, if heat persists from the fourth to the seventh day, pus and blood will appear in the stool.

In Shanghan, with little heat and mild Jue (only fingertips are cold), the patient is taciturn, has no desire to eat, and is vexed for several days. If urination is clear and white, this indicates the heat has been eliminated. If the patient desires food, the disease is healing. If Jue occurs accompanied by vomiting and fullness/vexation in the chest and hypochondrium, blood will likely appear in the stool later.

In Shanghan, fever lasts six days initially, but Jue lasts nine days with diarrhea. Usually, those with Jue and diarrhea cannot eat. If they can eat now, fear "Chu Zhong" (Elimination of the Middle, a false appetite indicating impending stomach Qi exhaustion). Feed them Suobing (noodle strips); if no fever ensues, we know Stomach Qi remains, and they will heal. Fear that a sudden burst of heat coming and going quickly indicates death. Three days later, examine the pulse; if heat continues, expect healing at midnight of the next day. This is because heat and Jue correspond, leading to healing. Three days later, if the pulse is rapid and heat does not cease, there is excess heat, which will inevitably cause carbuncles and sores.

In Shanghan, if Jue precedes fever and diarrhea, the diarrhea will stop spontaneously. If Jue recurs, diarrhea returns.

In Shanghan, if Jue precedes fever and diarrhea stops, but sweating occurs and the throat hurts, Bi (obstruction) of the throat will occur.

If there is fever without sweat, diarrhea will stop spontaneously; if it does not stop, pus and blood will appear in the stool. If pus and blood appear, the throat will not be obstructed.

In Shanghan, with a hurried pulse (Cu) and cold reversal of the hands and feet, moxibustion may be applied.

For cold reversal of the hands and feet with a fine pulse nearly absent, Danggui Sini Tang (Angelica Sinensis Decoction for Extremity Cold) is indicated. If there is long-standing internal cold, Danggui Sini Tang plus Wu Zhu Yu and Sheng Jiang (Evodia and Fresh Ginger) is indicated.

If a patient has cold reversal of the hands and feet, a suddenly tight pulse, fullness and vexation below the heart, hunger but inability to eat, the pathogen is knotted in the chest. Treatment should induce vomiting.

If a patient has cold reversal of the hands and feet, states they do not have Jie Xiong (Chest Binding), but has fullness and tenderness upon pressure in the lower abdomen, this is cold knotting at the Bladder Guan Yuan point.

In Shanghan, if Jue is accompanied by palpitations below the heart, treat the water retention first with Fuling Gancao Tang (Poria and Licorice Decoction), then treat the Jue. Otherwise, water will soak into the Stomach and cause diarrhea.

In Shanghan, four or five days later, abdominal pain with gas moving downward toward the lower abdomen indicates impending spontaneous diarrhea.

Diarrhea with a large pulse indicates deficiency caused by harsh purging. If the pulse is floating and wiry (Ge) with abdominal borborygmus, it belongs to the Danggui Sini Tang pattern.

Profuse sweating or severe diarrhea leading to cold reversal indicates Sini syndrome.

Profuse sweating with persistent heat, internal stiffness, limb pain, combined with diarrhea, cold reversal, and aversion to cold, indicates Sini syndrome.

Diarrhea of undigested food (Qing Gu), interior cold with exterior heat, sweating, and cold reversal indicate Tongmai Sini Tang (Pulse-Restoring Sini Decoction).

Shanghan originally presenting with cold-type diarrhea, mistreated with emesis and purging, leading to cold rejection and aggravated vomiting/diarrhea where food is vomited immediately upon ingestion, indicates Ganjiang Huanglian Huangqin Renshen Tang (Ginger, Coptis, Scutellaria, and Ginseng Decoction).

Dry retching with salivation and headache indicates Wuzhuyu Tang (Evodia Decoction).

Vomiting due to abscess pus requires no specific treatment for vomiting; once the pus is exhausted, it heals itself.

Vomiting with a weak pulse, free urination, slight fever, and cold reversal is difficult to treat; Sini Tang is indicated.

Diarrhea with a deep-string pulse indicates heaviness in defecation; a large pulse means the disease has not stopped; a weak-rapid pulse means it will stop spontaneously. Even with fever, death will not occur.

Diarrhea with a deep-slow pulse, slightly red face, slight fever, and diarrhea of undigested food will lead to Yu Mao (dizziness/heaviness like being wrapped), resolving with sweating. The patient will have mild cold reversal. This is because of Dai Yang (floating Yang on the face) and lower deficiency.

Diarrhea with a rapid pulse, slight fever, and sweating indicates spontaneous healing. If the pulse becomes tight again, the disease is unresolved.

Diarrhea with a rapid pulse and thirst indicates spontaneous healing; if unhealed, pus and blood in stool will occur due to heat.

Diarrhea with a floating-rapid pulse at the Cun position and a choppy pulse at the Chi position indicates pus and blood in stool.

Diarrhea with slight fever, thirst, and a weak pulse indicates spontaneous healing.

Diarrhea with desire to drink water due to heat is treated with Baitouweng Tang (Pulsatilla Decoction).

In Jueyin disease, if the patient desires water, giving small amounts will heal the condition.

Hot diarrhea with heaviness in defecation is treated with Baitouweng Tang.

Diarrhea with delirium indicates dry feces; Xiao Chengqi Tang (Minor Order the Qi Decoction) is appropriate.

After diarrhea, increased vexation with softness upon pressing below the heart indicates empty vexation; Zhizi Chidao Tang (Gardenia and Fermented Soybean Decoction) is appropriate.

Jueyin wind-stroke with a slightly floating pulse indicates impending healing; non-floating indicates not healed.

The time when Jueyin disease resolves is from Chou hour to Mao hour.

Non-healing (Misdiagnosis/Mistreatment leading to death): In Shanghan with a slow pulse, by the sixth or seventh day, administering Huangqin Tang (Scutellaria Decoction) to clear heat wrongly causes the abdomen to become cold. The patient should not be able to eat, yet eats now. This is named Chu Zhong (Elimination of the Middle) and results in death.

In Shanghan, five or six days later, no Jie Xiong, soft abdomen, deficient pulse, and cold reversal indicate that purging must not be used; this is loss of blood. Purging leads to death.

Fever with cold reversal, lasting seven days with diarrhea, is difficult to treat.

Shanghan with fever, severe diarrhea, and unceasing cold reversal is a death case.

Shanghan, six or seven days later, no prior diarrhea, sudden fever with diarrhea, and incessant sweating is a death case (Yin without Yang).

Shanghan with fever, diarrhea, cold reversal, restlessness, and inability to lie down is a death case.

Shanghan, six or seven days later, faint pulse, cold reversal of hands and feet, vexation; after moxibustion on Jueyin channels, if cold reversal does not return, it is death.

Diarrhea with cold reversal of hands and feet and absent pulse; after moxibustion, if not warm and pulse does not return, with slight panting, it is death.

After diarrhea, pulse vanishes and hands/feet are cold; if pulse returns and hands/feet warm, life; if not, death.

Shanghan diarrhea occurring ten-plus times daily with a surprisingly strong pulse is death.