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To understand the condition of a patient's Zang-Fu organs, a physician must inquire about what is discharged from the interior; therefore, in all diseases, one should examine the urine and stool. Zhang Zhongjing determined that interior heat in Shanghan (Cold Damage) by the presence of difficult urination and dark red urine, and determined the absence of interior heat by clear, unobstructed urination with pale urine. He determined interior heat by constipation and hard stools, and interior cold by spontaneous diarrhea accompanied by cold extremities. Thus, by examining the urine and stool, one can determine a person's cold or heat nature, dryness or dampness state, and deficiency or excess condition, without error. However, the discussion of urine and stool requires careful scrutiny. For instance, dry and bound stools indicate heat; yet, slippery diarrhea with yellow color also indicates heat, which people often overlook. Yellow-red urine indicates heat; yet, white but turbid urine can also indicate heat, which people often overlook. Again, dry and bound stools indicate heat; however, there are cases of blood depletion and fluid exhaustion where bitter-cold herbs are contraindicated. Similarly, yellow-red urine indicates heat; however, there are cases of food stagnation in the Middle Jiao causing yellow-red turbid urine, where cold-cooling herbs fail to clear the pathogen, while aromatic, drying, pungent, and warm herbs succeed in clearing and promoting diuresis.

Shanghan symptoms have four major junctions: Exterior, Interior, Yin, and Yang. Pulse qualities have four major distinctions: Floating, Sinking, Slow, and Rapid. A Floating pulse indicates an Exterior syndrome, a Sinking pulse indicates an Interior syndrome, a Slow pulse indicates Cold, and a Rapid pulse indicates Heat. This method uses Floating and Sinking to distinguish Exterior and Interior, and Slow and Rapid to distinguish Cold and Heat. Shanghan is a heat disease, so its pulse must be Rapid; Zhonghan (Cold Strike) is a Yin syndrome, so its pulse must be Slow. If a Rapid pulse is seen, even if symptoms manifest in the Yin meridians, it is still a heat disease caused by the transmission of Yang pathogens. If a Rapid pulse is seen, even if the hands and feet are cold, it is "deep heat leading to deep cold" (Re Shen Jue Shen), a false appearance of a Yang syndrome resembling Yin. Therefore, when treating Shanghan, upon seeing a Floating-Rapid pulse, indicating exterior pathogenic heat, one should treat according to the releasing-the-exterior methods of the Three Yang meridians. Upon seeing a Sinking-Rapid pulse, indicating interior pathogenic heat, even if the exterior syndrome is urgent, although the exterior is treated first, pungent-warm herbs are prohibited; instead, a method of pungent-cool dual resolution should be used. Once the exterior syndrome is resolved, the interior should be cleared. This discusses two principles based on pulse manifestation. Regarding the Sinking-Hidden pulse, there are three distinctions. One case is a Yang syndrome with a Sinking-Hidden pulse, which is not a Yin syndrome with interior cold, but rather Yang pathogens hidden internally, preventing sweating and exit; cold-cooling herbs are prohibited, and only ascending and dispersing methods for exterior pathogens are suitable, so that upon sweating, the pulse emerges. Another case is a Yang syndrome with a Micro pulse, indicating deficient and weak righteous Qi unable to sweat; when using releasing herbs to disperse Yang pathogens, a small amount of Renshen (Ginseng Radix et Rhizoma) is added to assist the deficient righteous Qi, allowing the releasing herbs to work better with Ginseng. Even in fatal cases of Yang syndrome with Yin pulse, such treatment may lead to survival. Another case is deficiency-cold of the Zang organs with a Sinking-Slow pulse, indicating Yin syndrome with Cold Strike, requiring urgent warming of the meridians and rescue of the interior. This distinguishes three conditions within the Sinking pulse: Hidden Pathogen, Righteous Deficiency, and Yin-Cold. The Sinking pulse of a Yin syndrome is Sinking, Slow, and distinct. The Sinking pulse of a Hidden Pathogen is Sinking, Hidden, Rapid, and blurred. The Micro pulse of Righteous Deficiency is regardless of Floating or Sinking, appearing weak and powerless upon prolonged pressing. Therefore, Slow and distinct pulses indicate interior cold. Sinking and Hidden pulses indicate that exterior pathogens cannot be vented. A Micro pulse in a Yang syndrome indicates excessive pathogen and deficient righteous Qi. Now, if there are symptoms of Yang pathogens but a Sinking-Hidden pulse appears, mistaking it for a Yin syndrome and using warm-hot herbs will cause internal eruption of Yang pathogens, leading to rapid death. If irritability and restlessness are seen and cold-cooling herbs are mistakenly used, it will suppress the release of exterior sweat. Thus, the principle of pulse diagnosis is to first distinguish the syndrome, and then deliberate based on the pulse. A Sinking pulse indicates purgation is needed; if the exterior syndrome is urgent, the exterior should still be dispersed first. A Floating pulse indicates sweating is needed; if there is interior heat, resolving both exterior and interior is necessary. If the purgation syndrome is urgent, dual resolution of exterior and interior is unavoidable.