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In general, if a patient presents with dry mouth and tongue, thirst accompanied by delirious speech, and constipation, it can be determined as a Heat syndrome. One must carefully distinguish cases of vomiting, diarrhea without thirst, or aversion to cold with abdominal pain to differentiate them as Cold syndromes.

If the pulse is deep, solid, and forceful, purgation (downward draining) is appropriate. If the pulse is deep, slow, and weak, warming is appropriate.

Dry mouth and throat, thirst with delirious speech, constipation, or hardness and pain around the navel, or diarrhea passing only clear water, hardness and pain in the epigastrium, are all caused by pathogenic heat and dry fecal matter accumulation. One should immediately use Liuyi Shunqi Tang (Six-Yi Harmonizing Qi Decoction) to purge according to the severity of the condition. (This is Chengqi Tang [Cassia Twig Decoction], with methods for modification.) In cases of no heat but aversion to cold, cold extremities with curling up, no thirst, or abdominal pain with vomiting, heavy diarrhea, or Yin Toxicity presenting with cyanosis of fingernails and lips, retching with colicky pain, body pain as if beaten by a club, facial discomfort as if scraped by a knife, and shivering, these are all caused by Cold pathogen directly invading the interior. One should immediately use Huiyang Jiuji Tang (Return Yang Rescue Crisis Decoction) to warm. (This is Sini Tang [Frigid Extremities Decoction], with methods for modification.)

Irritability, fullness, and retraction of the scrotum indicate involvement of the Foot-Jueyin Liver Meridian. If initially there is Xiao Ke (Wasting-Thirst/Irritable Thirst) with irritability and fullness, this is the root disease; subsequently appearing tongue retraction and scrotal contraction indicates the branch disease. There are both Cold and Heat presentations, so one cannot generally treat it as Heat alone.

Irritability, fullness, scrotal contraction, and Xiao Ke belong to Heat. Saliva spitting without thirst and cold extremities belong to Cold. Symptoms resembling malaria but without vomiting, and with normal urination and defecation, will likely resolve spontaneously.

A deep, solid pulse indicates suitability for purgation. A deep, slow pulse indicates suitability for warming. A floating, moderate pulse indicates the disease will resolve spontaneously.

Xiao Ke, irritability, fullness, tongue retraction, scrotal contraction, constipation, and hands and feet alternating between cold and warmth require immediate purgation with Liuyi Shunqi Tang. (This is Chengqi Tang, with methods for modification.) Saliva spitting, or cold extremities not warming beyond elbows and knees, no thirst, severe lower abdominal colic, and retching require immediate warming with Zhuyu Sini Tang. (This is Huiyang Jiuji Tang, with its own methods for modification.)

Someone asked: "To treat Shanghan (Cold Damage), one must first clarify the pulse and signs. Without clear pulse and signs, prescribing has no basis; once clarified, the physician becomes an expert. The character 'Mai' (Pulse) truly embodies the creation of Xiantian (Pre-heaven/Innate) and Hou Tian (Post-heaven/Acquired). What is Xiantian? What is Hou Tian? And what is Mai?" The answer was: "Human Yin and Yang constitute Xiantian. Human Qi and Blood constitute Hou Tian. Mai is neither blood nor Qi, but the precursor to Qi and Blood, being the pathway where Ying (Nutritive) Qi travels." Another question arose: "Having understood the pulse principles of Xiantian and Hou Tian, one must know the essentials of holding the pulse: Ju (Lifting), An (Pressing), and Xun (Searching). Without understanding these, how can one distinguish Yin/Yang, Exterior/Interior, Deficiency/Excess?" When holding the pulse, light palpation is called Ju. Heavy pressure is called An. Neither light nor heavy, seeking carefully, is called Xun. Initially, with light touch, if the pulse is felt at the skin level, it is called Floating (Fu), characteristic of the Taiyang (Greater Yang) meridian. Forceful indicates Cold pathogen in the Exterior; absence of sweating indicates Cold damaging Ying Blood, representing an Exterior Excess syndrome, suitable for diaphoresis (sweating method). Weak indicates Wind pathogen in the Exterior; presence of sweating indicates Wind damaging Wei (Defensive) Qi, representing an Exterior Deficiency syndrome, suitable for consolidating the exterior. If the pulse is felt beneath the muscle, between sinew and bone, it is called Deep (Chen), characteristic of the Three Yin meridians. All Three Yin pulses are Deep; the subtlety lies in distinguishing forceful from weak under the fingers. Forceful indicates Heat pathogen in the Interior, representing Interior Excess, suitable for purgation. Weak indicates Cold pathogen invading the Interior, representing Interior Deficiency, suitable for warming. With neither light nor heavy pressure, taking the middle position, the pulse corresponds to the flesh and blood layer, with equal Yin and Yang. If a slightly洪 (Hong/Surging) pulse is seen, it is the Yangming (Yang Brightness) meridian, indicating pathogen mostly in the Exterior with little in the Interior, suitable for resolving the muscle layer. If a string-like and rapid (Xuan Shu) pulse is seen, it is the Shaoyang (Lesser Yang) meridian, indicating pathogen in the Half-Exterior Half-Interior, suitable for harmonizing. The previously mentioned Yin/Yang, Exterior/Interior, Deficiency/Excess, Cold/Heat are all distinguished within the forcefulness or weakness of the Floating, Middle, and Deep pulses. Forceful indicates Yang, Excess, Heat. Weak indicates Yin, Deficiency, Cold. If the pulse is not visible in Floating, Deep, or Middle positions, one must search carefully; if it appears faintly or intermittently, it is a Hidden Pulse of Yin/Yang concealment, applicable to all three positions. Someone said: "Your clarity is profound, unrecognizable to vulgar minds. Among these three pulses, there are progression and retreat, hidden pulses, resolvable and non-resolvable types, intermittent pulses, and chaotic pulses. Please explain their origins." The answer was: "A large pulse indicates disease progression; largeness means pathogen is strong while healthy Qi is powerless. A slow/moderate pulse indicates pathogen retreat; moderation means Stomach Qi is harmonious and pathogen is powerless. What is a Hidden (Fu) pulse? No pulse on one hand is Single Hidden. No pulse on both hands is Double Hidden. If at the onset of illness there is headache, fever, and aversion to cold with a hidden pulse, it is because Yin pathogen has sunk into Yang, unable to vent; this desires sweating but requires purgation to allow pathogen retreat and healthy Qi recovery, after which the pulse returns and disease clears. Like weather becoming hot before rain, then cool after rain. However, if after seven or eight days there are no clashing symptoms, or the patient is comatose/unconscious, or the pulse is completely absent, this desires sweating but forbids purgation. Like dark skies after rain bringing life to all things, a auspicious sign of Yang transformation. What is resolvable vs. non-resolvable? Floating-moderate pulse in the Exterior resolves via sweating. Deep-solid pulse in the Interior resolves via purgation. Deep-slow pulse in the Interior resolves via warming. Although Floating suits sweating, Deep suits purgation/warming, why would Floating suit purgation and Deep suit sweating? The answer: Purging a Floating pulse is due to difficult defecation. If defecation were not difficult, how could one dare to purge! Sweating a Deep pulse is due to exterior heat. If the body were not feverish, how could one dare to sweat! What is intermittent pulse? If Cold pathogen directly strikes Yin meridians, and after warming the pulse remains intermittent, it is called intermittent. What is chaotic/restless? After sweating or purging, the pulse should calm; if it instead becomes vigorous and chaotic, it is called Chaotic, a sign of great misfortune. Then, does the gentleman speak with evidence? Alas, it is hard to explain fully; this comes from the standard principles of classic laws. The guest rose happily and thanked him: 'Though I am white-haired and endless in years, I have admired this throughout my life. Unexpectedly meeting you, I am fortunate to have my mind opened. It is like using a small mouse to fire a thousand-jin crossbow—very inappropriate—truly like cutting and polishing gems. Compared to modern vulgar people, I am indeed a chicken in a jar or a frog in a well, unaware that there is sky outside the jar and sea outside the well. Thank you for your enlightenment later on; are you not a reincarnated master!' Thus, it was recorded and transcribed to show posterity."