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Diseases caused by internal injury, as well as those due to overexertion and irregular diet, present with heat in the palms (Shouxin) while the backs of the hands (Shoubai) remain cool; conversely, external contraction of Wind-Cold (Fenghan) presents with heat on the backs of the hands while the palms remain cool. This distinction is extremely clear.

If injured by diet and overexertion, the external manifestations must appear at the mouth: there will inevitably be a loss of taste for grain foods, abdominal discomfort, and an unwillingness to speak. Even if answering reluctantly, the voice will necessarily be timid and weak, with excessive saliva and drool. There may or may not be clear nasal discharge; this constitutes a Yin syndrome (Yin zheng). If externally contracted by Wind-Cold, the external manifestations must appear at the nose: nasal breathing will be obstructed, the voice heavy and turbid, speech congested and unsmooth, yet loud and powerful, while the sense of taste in the mouth remains normal. In Cold Damage (Shanghan), the face becomes red, and the nose is congested and dry; in Wind Injury (Shangfeng), only clear nasal discharge occurs. The *Neijing* states: "The nose is the manifestation of the Lung; Lung Qi connects with Heaven." External contraction of Wind-Cold causes nasal obstruction. The mouth belongs to Kun Earth (Spleen); Spleen Qi connects to the mouth. Due to irregular diet and overexertion, one loses the taste for grains and the five flavors. It is also stated: "Those injured by food have an aversion to eating," which is quite evident.

In cases of external Wind-Cold contraction, the Qi is congested, abundant, and excessive. In cases of internal injury from diet and overexertion, the Qi in both the mouth and nose is short and rapid, insufficient for respiration. How are they distinguished? Generally, in external Wind-Cold contraction, the primordial Qi of the Heart and Lungs is initially undiminished, and the pathogenic Qi adds to it, causing nasal congestion and obstruction. The face becomes red, and air cannot exit through the nose but exits through the mouth. When speaking any sentence, the tone is light at the beginning and heavy at the end; the pitch is high, and the voice is vigorous, harsh, and powerful. In Cold Damage, symptoms include a dry nose without discharge, a congested red face, speech that is light at the beginning and heavy at the end, and a vigorous, harsh, and powerful voice; these are signs of excess (Yu). In Wind Injury, there is invariably clear nasal discharge, a hoarse voice, and speech that sounds resonant as if coming from a jar; it is also light at the beginning and heavy at the end, with a high pitch and power; these are all signs of abundant and excessive Qi.

In cases of internal injury from diet and overexertion, the Qi of the Heart and Lungs is first damaged and injured by Heat. Since Heat damages Qi, the limbs become weak and unable to move. Consequently, there is shortness of breath and scanty Qi in both the mouth and nose, upper asthma (wheezing), and reluctance to speak. When asked questions, one is unwilling to answer even one out of ten. Even if answering reluctantly, the Qi is timid and the voice low; these are signs of deficient and insufficient Qi. Such clarity allows even women to distinguish between them; how could a physician fail to do so?