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Each of the Five Zang organs has its specific dominion, and their pathological manifestations invariably appear according to the affected organ. Red complexion, excessive laughter, cracked tongue, dry mouth, irritability, heat in the palms, heart pain accompanied by hiccups, and pulsation above the umbilicus indicate a disease of the Heart (Xin). Cyan complexion, frequent anger, painful hardness in the hypochondrium, cough with rebellious Qi, dizziness, spasms and cramps of the limbs and joints, difficult urination, and pulsation to the left of the umbilicus indicate a disease of the Liver (Gan). (Liver Wood overacting on Spleen Earth with retained fluid causes cough and rebellious Qi. The Foot Jueyin Liver meridian terminates at the genitalia, causing difficult urination.) Black complexion, fearfulness, yawning and groaning, toothache, bone weakness, tinnitus, seminal emission, coldness of the lower legs, pain in the waist and spine, acute pain in the lower abdomen, abdominal masses with diarrhea and tenesmus, and pulsation below the umbilicus indicate a disease of the Kidney (Shen). White complexion, frequent sneezing, sorrow and desire to cry, asthma and cough with rebellious Qi, throat obstruction, aversion to wind and cold, alternating chills and fever, and pulsation to the right of the umbilicus indicate a disease of the Lung (Fei). Yellow complexion, excessive thinking, frequent belching, somnolence, fullness in the epigastrium, indigestion, generalized edema and heaviness, and soreness and pain in the limbs and joints.

When the Kidney is diseased, hearing is impaired; when the Spleen is diseased, eating is impaired; when the Heart is diseased, tongue movement is impaired. Observing the pathological manifestations of the Five Zang organs as described above, one does not need wisdom to understand them. However, why does the Heart dislike Heat? Because Heat causes blood vessels to become disordered and turbid. Why does the Liver dislike Wind? Because Wind causes tendons to become dry and tense. Why does the Kidney dislike Dryness? Because Dryness causes essence to be depleted. Why does the Lung dislike Cold? Because Cold causes Qi stagnation. Why does the Spleen dislike Dampness? Because Dampness damages muscles; damaged muscles lead to flaccidity and swelling. Tracing the origin of diseases of the Five Zang organs, do they not all arise from the nature of the pathogenic factors received? Therefore, excess of Zang Qi is termed Excess (Shi), and deficiency of Zang Qi is termed Deficiency (Xu).

Manifestations of Heart Excess: dry mouth, excessive laughter, body heat, hematuria or bleeding from sweat, pain and fullness in the chest, epigastrium, back, and between the ribs. Manifestations of Liver Excess: red eyes, irritability, dizziness, deafness, pain radiating to both hypochondria and lower abdomen. Manifestations of Kidney Excess: abdominal distension, bodily swelling, shortness of breath and reluctance to speak, bone pain, undigested stool in diarrhea, and yellow urine. Manifestations of Lung Excess: rapid breathing and cough, rebellious Qi with nasal flaring, pain in calves, thighs, and shoulders, and fullness in the chest. When Spleen Qi is in Excess, it inevitably leads to heavy limbs that are difficult to lift, abdominal distension, urinary retention, and a sensation of hunger that is distressing. Thus, "excess of Zang Qi is termed Excess" refers to this.

Manifestations of Heart Deficiency: mental confusion, frequent fright, anxiety and vexation, lack of luster in the complexion, coughing and spitting, stiff tongue, and soreness and pain in the waist and back. Manifestations of Liver Deficiency: blurred vision, chest pain, stiffness and spasms of tendons and hypochondrium, fearfulness with cyan complexion, feeling as if being hunted. Manifestations of Kidney Deficiency: sensation of emptiness in the heart like hunger, chest pain radiating to the spine, cold extremities, abnormal urination, and tinnitus. Manifestations of Lung Deficiency: shortness of breath, runny nose, dry throat, wheezing sounds in the lungs, asthma, and hemoptysis. (Red threads in sputum indicate lung damage due to Heat injuring the tissue. If there is pain under the hypochondrium and expectoration of fresh blood, this indicates Heat injuring the Liver.) If vomiting, diarrhea, indigestion, abdominal distension with borborygmus, and weakness of the four limbs occur, these are manifestations of Spleen Deficiency. Thus, "deficiency of Zang Qi is termed Deficiency" refers to this.

Generally, Excess conditions are treated with draining methods, and Deficiency conditions with tonifying methods. One must avoid excess and insufficiency, aiming for balance. Otherwise, one may cause the Excess to become more Excess and the Deficiency to become more Deficient, damaging what is insufficient and augmenting what is already excessive. As Mr. Su Dongpo stated, "Extreme Deficiency may present with vigorous symptoms, and extreme Excess may present with emaciated signs." A difference of a hair's breadth, amidst seemingly similar conditions, can determine life or death, fortune or disaster. Alas! How fearful this is!

Regarding Heart disease presenting with fixed staring and darkened complexion; Liver disease with curled tongue and retracted testicles; Kidney disease with sensation of broken waist and withered bones; Lung disease with withered hair and escaping Qi; Spleen disease with protruding umbilicus and inverted lips—these represent the exhaustion of the Qi of the Five Zang organs. Exhaustion implies no possibility of recovery; even if met with masters like Qibo or Bian Que, nothing can be done. Nevertheless, diseases also differ in their Excess and Deficiency patterns. Abundant pathogenic Qi constitutes Excess; depleted vital Essence constitutes Deficiency. Pulse surging, skin hot, abdomen full, and blockage of anterior and posterior orifices constitute the Five Excesses; pulse fine, skin cold, shortness of breath, diarrhea of anterior and posterior orifices, and inability to eat constitute the Five Deficiencies. Diseases emerging from within are Deficiency; entering from without are Excess. (Yin exiting to attack Yang, Yang entering to attack Yin.) Ability to speak is Deficiency; inability to speak is Excess. Slow pulse is Deficiency; rapid/tense pulse is Excess. (Yin is quiet thus slow; Yang is active thus tense.) Soft pulse is Deficiency; firm pulse is Excess. Itching is Deficiency; pain is Excess. Pain externally but comfort internally indicates External Excess and Internal Deficiency; comfort externally but pain internally indicates External Deficiency and Internal Excess. If there is pain inside and out in the heart/abdomen and skin, relief upon pressure indicates Deficiency; increased pain upon pressure indicates Excess. The Classics state: Skin Deficiency leads to heat; Pulse Deficiency leads to fright; Muscle Deficiency leads to heaviness; Tendon Deficiency leads to spasms; Bone Deficiency leads to pain; Marrow Deficiency leads to collapse; Intestine Deficiency leads to loose stools. Three Yang Excess and Three Yin Deficiency result in no sweating; Three Yin Excess and Three Yang Deficiency result in incessant sweating. Furthermore, floating and slow pulse with spontaneous sweating and aversion to wind requires muscle-releasing methods; floating and tight pulse with no sweating and aversion to cold requires diaphoretic methods. This represents the Excess and Deficiency of Exterior diseases. Deep and firm pulse with abdominal pain and constipation requires purgative methods; deep and weak pulse with cold extremities and spontaneous diarrhea requires warming methods. This represents the Excess and Deficiency of Interior diseases. In cases of Internal Excess, hardness and strength below the heart, abdominal pain and fullness, blockage of anterior and posterior orifices, and dry heaving without expulsion indicate a fatal prognosis. In cases of Internal Deficiency, cold extremities, restlessness, vomiting, and unceasing diarrhea indicate demise. These are also matters that must not be ignored. Hence, they are discussed together.