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Ancient physicians stated that external pathogens enter the body via the meridians, while internal diseases arise from the stagnation and eruption of the five Zang organs. However, one must seek definitive evidence to verify diagnoses, thereby avoiding errors. For instance, in Shanghan (Cold Damage) disease, there are Yin and Yang, Exterior and Interior patterns. Yang patterns often present with excessive talking, whereas Yin patterns are silent; Yang patterns worsen during the day, while Yin patterns intensify at night; a Yang pattern may mimic a Yin pattern, presenting with black stool but a slippery pulse; conversely, a Yin pattern may mimic a Yang pattern, presenting with a red face but a faint pulse.

Symptoms such as heavy body, back pain, restlessness, delirious speech, running about, sore throat, mottled skin resembling cotton textures, or dysentery with red and yellow stools, are often caused by the reckless consumption of drying-hot medicines or spicy-hot foods, constituting Yang Du (Yang Toxin). Stiffness of the back, colicky abdominal pain, a sensation as if beaten by a club, dry thirst, vomiting and diarrhea, cold sweating, and repetitive speech (Zheng Sheng) are clearly due to deficiency-cold of the Spleen and Stomach compounded by secondary exposure to cold, constituting Yin Du (Yin Toxin).

Regarding the two types of Jue (Reversal/Cold Extremities) syndromes: in Yang Jue, the fingernails and toenails are sometimes warm, or the patient fears heat, desires water, throws hands and feet about, is irritable and restless unable to sleep, has constipation, dark urine, and exterior signs of confusion and stupor. In Yin Jue, the nails and toes are constantly cold, legs are often curled up, the patient fears cold, pulls clothes to cover themselves, does not desire water, may have clear diarrhea or normal bowel movements, frequent urination, and exterior signs of being alert yet quiet.

Exterior patterns typically present with aversion to cold without thirst, fever, and body pain. Interior patterns typically present with thirst, aversion only to heat, panting and fullness, dry mouth and throat, sweating in the palms and axillae, hard stool, yellow saliva, and delirious speech.

In the initial stage of Shanghan, symptoms include fever, aversion to cold, anhidrosis, and a miserable complexion. If exposed to wind again, aversion to cold increases, and extremities are slightly cold. If fever is accompanied by diarrhea but extremities remain warm, prognosis for survival is good; if extremities are cold and do not warm even after moxibustion, the condition is extreme. Zhong Han (Mid-Cold) presents with locked jaw, rigid limbs, aphonia, sudden fainting, vomiting of frothy saliva, and convulsions of hands and feet, resembling stroke (An Feng). Alternatively, re-exposure to dry-heat wind injury presents with sweating, aversion to wind, a lustrous rather than miserable complexion, slight warmth in extremities upon cold exposure, fever, and irritability. If it is Wind Stroke (Zhong Feng), there is hemiplegia, limb paralysis, flooding of phlegm causing stupor, deviation of mouth and eyes, and numbness of skin and muscles. If the pathogen resides in the Six Fu organs, the course is relatively slow, allowing life to be prolonged for years. If it resides in the Five Zang organs, symptoms include closed eyes, open mouth, scattered hands, snoring-like sounds, enuresis, and successive malignant signs leading to death within a day.

Shang Shu (Summerheat Injury) presents with fever, aversion to cold, headache, irritability, thirst, dizziness, cold back, and greasy face, possibly with vomiting or diarrhea. If the pathogen enters the Heart, it causes chest oppression and unconsciousness; if it enters the Liver, it causes dizziness and stiff paralysis; if it enters the Spleen, it causes deep sleep and unawareness; if it enters the Lungs, it causes panting, fullness, and flaccidity; if it enters the Kidneys, it causes Xiao Ke (Wasting-Thirst) and frequent urination. Regarding Shi (Dampness) injury, symptoms include heavy body, heavy joint pain, fever, aversion to cold, loose stools, scanty urine, cold waist and legs, swollen knees, or spontaneous diarrhea without thirst. If Qi is unbalanced, pathogenic invasion can also cause hemiplegia, facial deviation, phlegm flooding with stupor.

Regarding the Seven Emotions: Joy injuring the Heart contraindicates fast walking or standing for long periods. Anger injuring the Liver causes rebellious Qi that is unbearable, heat rushing to the heart, shortness of breath nearly to cessation. Sorrow injuring the Lungs causes tightness of the Heart vessel, closure of the Upper Jiao, obstruction of Ying and Wei Qi, and restless sleep. Overthinking injuring the Spleen causes Qi stagnation, accumulation in the Middle Jiao, inability to eat, abdominal distension, and limb lethargy. Grief injuring the Pericardium causes forgetfulness, failure to recognize people, inability to find misplaced objects, tendon cramping, and limb edema. Fear injuring the Kidneys causes closure of Upper Jiao Qi and stagnation of Lower Jiao Qi, indecision, vomiting, and nausea. Shock injuring the Gallbladder causes loss of spirit anchoring, unsettled thoughts, and impulsive speech. Although these seven manifestations differ, they all stem from Qi. When Zang Qi fails to circulate, stagnation leads to the formation of phlegm-saliva, which accumulates into hard masses in the chest and abdomen or blocks the throat like a plum pit, difficult to expectorate or swallow, causing near-fainting episodes and hindering diet.

Various deficiency-consumption patterns present with dizziness, blurred vision, clear nasal discharge, turbid urine with spermatorrhea, cold watery diarrhea, undigested food, spontaneous sweating, and vomiting of clear phlegm, all indicating Yang deficiency and Yin excess. Various excess-heat patterns involve accumulation of heat in the five Zang organs, bitter taste, cracked lips with sores, dry intestines and stomach, irritability preferring cold, thick saliva, excessive eye discharge, red eyes, or generalized carbuncles.

Generally speaking, Malaria patterns are numerous: Chuan Nue (Cold Malaria) starts with chills then fever; Wen Nue (Warm Malaria) starts with fever then chills; Shu Nue (Summerheat Malaria) has fever without chills; Shi Nue (Damp Malaria) has chills, fever, heaviness, pain, and distension; Pin Nue (Female Malaria) has more chills than fever. Daily attacks are easy to cure; every-other-day attacks are manageable; every-three-day attacks are difficult to cure. Although this disease is traditionally avoided by doctors, knowing the cause removes the difficulty. Yi Ji (Epidemic Disease) presents with complex symptoms: fever, stiff lower back pain, contracted legs unable to extend, feeling as if knees will break, visual disturbances, alternating chills and fever, named Wen Yi. Trembling uncontrollably, internal heat, dry mouth, tongue ulcers, throat blockage, and hoarseness constitute Zao Yi (Dry Epidemic). Heavy head, stiff neck, rigid skin and muscles, or nodules arising on the sides of the throat and neck with heat-toxin spreading in skin and muscle layers constitute Han Yi (Cold Epidemic). Alternating chills and fever, damaging Lung Qi, sudden cough and vomiting, or fever with macules, panting, and coughing constitutes Shi Yi (Damp Epidemic). Seasonal infections manifest in hundreds of ways; accurate diagnosis requires careful differentiation according to the season.

Panting with continuous sputum indicates survival; spontaneous sweating, delirium, and fixed gaze indicate death. Hemorrhagic patterns include sudden hematemesis or epistaxis, ranging from one or two sheng to over a dou. Caused by four Qi pathogens circulating through meridians, winning/losing between Yin and Yang, or anger injuring the Liver, wind entering the intestines/stomach causes blood to coagulate in cold and overflow in heat, surging through organs and meridians, stopping in the chest/stomach, causing fullness, hematemesis, epistaxis, or bloody diarrhea. Cough with red threads is difficult to cure. Sudden passage of black blood indicates Heart exhaustion. Lao Zhai (Consumptive Disease) is often hidden by patients who refuse treatment, unaware that worms gnaw the lungs and heart, warranting deep concern. Gu Du (Gu Poison) presents with colicky abdominal pain as if bitten, vomiting and defecating blood resembling rotten meat. Verification involves spitting into water; sinking indicates authenticity. Xiao Ke adjacent to turbid urine should not be mistaken for abscesses, or peace is unlikely.

For dysentery: cool body, ability to eat, and free urination indicate ease of cure. Fever, profuse sweating, severe thirst, obstructed urination, cold extremities unresponsive to moxa, mild panting, and anorexia indicate death. Constipation with occasional urinary drops is easy to cure. Prolonged constipation with upper abdominal pain, shortness of breath, cold body, black face, and total obstruction of bowels/bladder is Qi Excess, leading to rapid death. Distension recent in onset, fluctuating, with soft abdomen, no diarrhea/panting, responds well to treatment. Protruding umbilicus, post-evacuation urgency, chronic emaciation, and restless panting indicate Spleen and Kidney failure, with no hope of recovery. Favorable edema descends from top to bottom in men and bottom to top in women; early intervention with diuretics reduces swelling and calms panting, leading to cure. Unfavorable edema presents with swollen limbs, protruding umbilicus and palms, voice loss, transverse blue veins on abdomen, cyanotic swollen nails, dark face, vomiting, and heavy head, rendering it incurable. Huo Luan (Cholera/Vomiting-Diarrhea) is the most acute, caused by irregular lifestyle and poor regulation; sudden chaos leads to suffocation and death, very fearful. Approaching danger is likened to treading on tiger tails. Li Feng (Malignant Wind/Leprosy), also called Da Feng or Feng Lai, presents with ruined cracked skin, ulcerated brows/face, snake-skin peeling, collapsed nose bridge, and is fatal in ten out of ten cases.

Zheng Zha (Masses): Zheng is hard and difficult to break; Zha is false/shifting, taking shape from external factors. Conditions like dragon/snake/turtle meat reactions or lice/rice grains are not fixed names but result from food interactions. Bad dreams and fear constitute Gui Huo (Spirit Affliction). Alas! Internal and external...