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The essence of disease lies in Yin and Yang. The trend of disease manifestation lies in Cold and Heat. However, the generation of Cold and Heat must have its causes. When Yang is deficient, there is external Cold; when Yin is deficient, there is internal Heat; when Yang is excessive, there is external Heat; when Yin is excessive, there is internal Cold.

Initially, Qi receives Qi from the Upper Jiao (Upper Burner) to warm the muscles and skin. If pathogenic Cold suddenly attacks, causing the Upper Jiao to be obstructed, then the internal Yang cannot exit, leaving only Cold stagnating externally. This is External Cold due to Yang deficiency.

Excessive labor and physical decline damage Liver Qi. Liver Qi stagnation overacts on Spleen Earth, leading to insufficient Qi from grain and water (Gu Qi). Insufficient Gu Qi causes the Qi of the Upper Jiao to fail to descend, and the Lower Wan (lower opening of the stomach) becomes obstructed. Consequently, Stomach Qi stagnates and transforms into Heat, remaining in the chest. This is Internal Heat caused by impaired Spleen function. This is Internal Heat generated by Yin deficiency.

Furthermore, if desires are not regulated, the Five Zang organs lose their retention, damaging Jing (Essence). Damage to Jing leads to a deficiency of Water (Kidney Yin), which also constitutes Internal Heat due to Yin deficiency.

Regarding External Heat due to Yang excess: when pathogenic Cold obstructs the Upper Jiao, the muscle surface and pores become tightly closed. Wei Qi (Defensive Qi) stagnates and accumulates, generating external Heat. This occurs because Yang is blocked by Cold and forced outward, creating external Heat.

Regarding Internal Cold due to Yin excess: Jue Qi (Rebellious Qi) moves upward, and Cold remains in the Middle Jiao, causing Yang to depart. The pulse is large and choppy. Cold obstructs the Middle Jiao, hence the pulse is large and sluggish/choppy due to lack of flow. All these are caused by Yin excess; thus, Yin excess generates Internal Cold.

Cold damages the Form (Xing), while Heat damages Qi. Damage to Qi causes pain; damage to Form causes swelling. Cold, being Yin, can damage Blood; thus, it damages the Form. Heat, being Yang, can damage Qi; thus, it damages Qi. Qi is formless; therefore, when damaged, it manifests as pain. Blood has form; therefore, when damaged, it manifests as swelling.

Extreme Cold generates Heat; extreme Heat generates Cold. Cold Qi generates Turbid Yin; Hot Qi generates Clear Yang. Cold generates Turbid Yin, and Heat generates Clear Yang; this is the normal state. However, if Clear Yang is located below, it causes Sundun Diarrhea (incomplete digestion diarrhea), because pathogenic Heat fails to digest food, resulting in undigested stool exiting whole. If Turbid Qi is located above, it causes abdominal distension, because Turbid Pathogen fills the Danzhong (Chest/Middle), and Danzhong fails to transform Qi, termed abdominal distension. This is called "Yin and Yang acting in reverse."

When Yin prevails, there is Cold; when Yang prevails, there is Heat. Extreme Cold transforms into Heat; extreme Heat transforms into Cold. Peace exists when Yin and Yang do not overpower each other. Yin prevailing is like Water invading and extinguishing Fire; Yang prevailing is like Fire scorching and drying up Water. Extreme Cold leads to Heat; extreme Heat leads to Cold. At the extreme of Yin, Yang is born (Winter Solstice); at the extreme of Yang, Yin is born (Summer Solstice). From this, one can understand the principle.

Cold and Heat contend, with different causes of contraction and different sites of reception. Thus, they are distinguished by the quantity of pathogen contracted and received. Some present with Heat and vexation/fullness because their Yin Qi is scant and Yang Qi is abundant, so Yang Pathogen fills the Yin aspect. Some generate Cold from within because their Zheng Qi (Upright Qi) has always been stagnant with many Bi syndromes, meaning Yang Qi is scarce and Yin Qi is abundant, preventing Ying (Nutritive) and Wei Qi from reaching the periphery, so Cold generates internally, known as Cold Bi. Some experience limbs feeling like roasting or burning upon exposure to Wind-Cold because their Yin Qi is deficient and Yang Qi is abundant. The Yang of the limbs combines with external factors, but little Water cannot extinguish the blazing Fire, so Yang alone prevails, causing the flesh to seem scorched.

More remarkably, although Cold obstruction previously caused Bi disease, now the body feels even colder, unable to be warmed by hot water or fire or thick clothing, yet without freezing stiff. This is because the person historically engaged in work involving water, causing Taiyang Qi to decline, Kidney Marrow Essence to dry up and fail to nourish bone marrow, failing to fill Qi. Both interior and exterior are dried out, causing cold penetrating to the bones. However, since the single Water of the Kidney is exhausted, the Fire of Liver and Heart stands alone. Yin is deficient inside and out, while floating Yang holds sway internally. Thus, although cold, it does not freeze stiff; this is named Bone Bi. Bone Bi should involve joint contracture.

Those suffering from Heat diseases with pain occur because the Yangming channel enters Yin. In Heat diseases, if the Renying pulse (Yangming artery) is one-fold stronger, it corresponds to Shaoyang; two-fold stronger, to Taiyang; three-fold stronger, it reaches extremity in Yangming. When Yangming is extremely excessive, it must enter Yin. When Yang enters Yin, both Yin and Yang become excessive, resulting in disease in the head and abdomen, manifesting as abdominal distension and headache.

There are cases where Qi rebellion causes Cold and Heat among Zang-Fu organs to shift into one another. When human Qi is harmonious, Yin and Yang are harmonious; when Yin and Yang are harmonious, Qi and Blood do not become overly fluid or rigid. Once Qi and Blood become overly fluid or rigid, Yin and Yang cannot interpenetrate and instead overcome each other. This is referred to as "returning without turning," where all Qi rebels. Thus, fluid meets fluid, and rigid meets rigid, inevitably causing mutual shifting. Shifting implies overcoming. A single Qi rebellion gives rise to various diseases; hence the chapter is titled "Qi Rebellion." The shifts are described below:

Kidney transfers Cold to Spleen, causing edema and shortness of breath. This is "Fluid meeting Fluid." The Kidney harbors True Fire, which not only warms Cold Water but also acts as the Mother of Earth to facilitate transformation. This is the True Fire of the Mingmen (Gate of Life). Now, only Cold Water Qi remains, which counter-transfers to overcome the next element, invading Spleen Earth. Thus, Spleen Earth loses its warming and drying Qi for a long time. Hence, edema and shortness of breath occur, likely because extreme Cold makes Yang微弱 (weak), unable to transform Qi.

Spleen transfers Cold to Liver, causing edema and tendon cramping. Liver Wood is warm and spreading, aiding Spleen dispersal. However, Wood feeds on Grain from Earth and relies on the Middle Jiao's nourishment. Now, Middle Earth is dominated by Cold. Since Earth loses its vibratory generation, Wood lacks Qi to ascend, inevitably transferring Cold to the Liver. Earth Cold causes edema; Wood failure causes Tendon Cold, leading to contracture.

Liver transfers Cold to Heart, causing mania and chest obstruction. The Heart houses the Shen (Spirit), and its Fire is born from the Liver. The Ying Blood stored in the Liver is precisely the Ying Blood governed by the Heart. Now receiving Liver's Cold rebellion, both Ying and Shen lose support, becoming disordered and manic. Moreover, the Heart governs Blood vessels (Yin); suppressed and stagnant, it blocks in the Danzhong, termed Tun Gao (accumulated fat/oil), causing chest obstruction.

Heart transfers Cold to Lung, causing Lung Xiao (Wasting-Thirst). Lung Xiao involves drinking one unit and urinating two units, a fatal untreatable condition. The Lung governs Qi and regulates water passages. Its ability to regulate water with restraint depends on Warm Qi for movement. Thus, *Neijing* states: "The Lung's association is with the skin; its master is the Heart." Does this not rely on the Heart constantly providing Warm Qi to dominate and moisten the Dry Metal? Now, Heart Fire is insufficient, failing not only to warm/nourish Lung Metal but transferring Cold to it. Cold combining with Metal makes Metal cold. Cold Metal causes Qi to sink and fail to rise. With ditches below but no rain above, drinking one results in urinating two. Lung Qi descends and withers; this is Lung Xiao, fatal and untreatable. The Heart and Lung dominate the Danzhong, serving as the dignitaries of Sovereign and Minister, assisting spirit and enlightenment. Now both are cold and lose their will. Is this merely the daily exhaustion of the root and loss of gatekeeping?

Lung transfers Cold to Kidney, called Yong Shui (Surging Water). Yong Shui means Water Qi lodges in the Large Intestine, like a bag holding liquid. Physical cold and cold drinks cause Lung Qi insufficiency and Lung Cold. Mother disease transmitting to Child allows Cold to transfer to the Kidney. The Kidney is Cold Water; Cold supplementing Cold causes Water Qi to fail to rise, becoming Surging. Water surges not in the Kidney but lodges in the Large Intestine because the Large Intestine is the lower stream of the Lung, returning to the Fu organs. Like a bag, it wraps but cannot disperse.

Cold can transfer; Heat can also transfer, termed "Rigid overcoming Rigid," causing Yang Qi to scatter and break. Thus, Spleen transfers Heat to Liver, causing fright and epistaxis. Spleen transferring Heat to Liver is counter-transferring to overcome, representing Dry Earth and Withered Wood, extreme Heat. Liver deficiency primarily causes fright/terror. Now Dry Earth transfers Heat to Wood, damaging its blood-storing function, causing fright and epistaxis.

Liver transferring Heat to Heart is fatal. The Liver stores Blood; heated, the Liver withers and cannot offer Ying to the Heart. Now Wind-Heat transfers, causing Heart Ying to wither. Wood and Fire burn together; Kidney Water cannot save it, and only the Sovereign Fire burns itself. Hence, death.

Heart transferring Heat to Lung transmits to Ge Xiao (Diaphragm Thirst). The Lung is originally Dry Metal; Heart transfers Heat to it, creating Fire-Dryness combination. This causes vexation in the upper diaphragm/jiao, excessive thirst, and rapid consumption. The previous Lung Xiao was due to Cold; this Ge Xiao is due to Heat. Thus, Xiao (Thirst/Wasting) has Yin and Yang aspects and must be distinguished.

Lung transferring Heat to Kidney transmits to Rou Jing (Soft Spasm). The Kidney governs bones and is the official of strength. Lung transferring Heat causes Essence to evaporate and bones to wither; Essence provides no benefit. Hence, Rou Jing.

Kidney transferring Heat to Spleen transmits to Xu Lao (Deficiency Consumption) and Chang Pi (Dysentery/Bloody Stool), fatal and untreatable. Kidney transferring Heat to Spleen is Yin Fire flaming upward. Pathogenic Heat is below, True Yin is depleted, and it carries Heat upward to assist Spleen. This is Yin deficiency counter-overacting, causing both Water and Earth to fail. Hence, Chang Pi. If such, initially transferred deficiency is compounded by excessive Heat injuring Spleen; how could it not fail?

Bao Gong (Uterus/Bladder area) transferring Heat to Bladder causes Long (Strangury/Difficult Urination) and Hematuria. Bao refers to the Uterus. In men, it is the Sea of Essence; in women, the Chamber of Blood. Mingmen Fire excess causes Bao Gong to transfer Heat to the Bladder, causing difficult urination (Long), and severely, hematuria. Generally,妄动 (reckless movement) of Minister Fire, rebellious and obstructed, often suffers this.

Bladder transferring Heat to Small Intestine causes Ge Chang (Diaphragmatic Intestinal Obstruction) and oral ulcers (Kou Mi). Unresolved Bladder Heat transfers to the Small Intestine. The Small Intestine meridian follows the throat down through the diaphragm. Receiving Heat causes Ge Chang obstruction. Thus, blockage prevents flow, stagnating in the meridian, invading the throat and cheeks, forming oral ulcers.

Small Intestine transferring Heat to Large Intestine forms Jia Masses and Chen Hernias. Small Intestine Heat moving downward transfers to the Large Intestine. Lower Jiao stagnant Heat fails to dissipate, lingering in convoluted areas, forming Jia masses. Chen refers to sinking below.

Large Intestine transferring Heat to Stomach causes increased appetite but emaciation, also called Shi Xuan. Large Intestine transferring Heat to Stomach is Dry-Heat moving upward. Hence, efficient digestion of grains. Yangming governs muscles; now Yangming Dry-Heat causes emaciation, termed Shi Xuan.

Stomach transferring Heat to Gallbladder is also called Shi Xuan. The Gallbladder uses Shaoyang Harmonious Qi to circulate through the San Jiao, assisting the Stomach in rotting and ripening food. Now Yangming Meridian Heat is severe, transferring Heat to the Gallbladder. This is Wood-Fire combined Pathogen, unable to generate Spleen. Hence, eating much but losing weight, termed Shi Xuan.

Gallbladder transferring Heat to Brain causes Xin E (numb/painful forehead) and Bi Yuan (Nasal Sinusitis/Oozing Nose). Bi Yuan is continuous discharge of turbid mucus. Xin E is stabbing pain in the forehead, transmitting downward to Ni Mie (epistaxis/blindness). The Gallbladder meridian ascends to the head corners. The Brain is the Mansion of the Mysterious Pearl, the Essence of the Kidney. Shaoyling connects to the Kidney; thus, its Heat follows the Chong and Du meridians, entering the Brain along its channels. The Brain cannot withstand Heat, causing numb/stabbing forehead pain.辣气 (pungent Qi) first appears at the forehead gate, leading to turbid mucus discharge or yellow turbid water, all Bi Yuan. If Heat persists, it transmits to epistaxis and blindness. All the aforementioned Cold and Heat items result from Qi Rebellion.

Whenever Yin or Yang prevails, there are manifestations. Yang prevalence causes body heat, closed pores, coarse breathing, difficulty bending/straightening, anhidrosis with heat, dry teeth, vexation, abdominal fullness leading to death. Yin prevalence causes body cold, sweating clear fluid, shivering chills and cold limbs, cold limbs extending to abdominal fullness leading to death. Yang Pathogen becoming Excess, with pathogens inside and out, is Yin Absolute (Yin Jue), hence death. Yin Cold taking charge leading to abdominal fullness, with Yin Pathogen becoming Excess, Yin inside and out, is Yang Absolute (Yang Jue), hence death. Generally, when symptoms reach abdominal fullness, Yangming also fails, unable to sustain, hence death.

All diseases have Shun (Smooth/Favorable) and Ni (Reverse/Unfavorable) patterns. Examining disease must start here; one must know this. Qibo said: Abdominal distension, body heat, and large pulse constitute the First Reverse. Body heat and large pulse indicate Pathogen excess externally. Adding abdominal fullness means Pathogen fills interior and exterior, i.e., the abdominal fullness death mentioned earlier.

Abdominal borborygmus and fullness, limb fullness and diarrhea, with a large pulse constitute the Second Reverse. Borborygmus and fullness, cold limbs with diarrhea, complete Yin syndrome. A large pulse is inappropriate; a large pulse indicates Ge Yang (Repelling Yang), constituting the Second Reverse.

Epistaxis unceasing with a large pulse constitutes the Third Reverse. Epistaxis with a large pulse in Yin vessels indicates Yang. Yang Excess and Yin Deficiency constitute the Third Reverse.

Cough with hematuria, emaciation, and small/tense pulse constitute the Fourth Reverse. Cough, hematuria, and emaciation indicate declining Zheng Qi. Tense pulse indicates Pathogen remains. Pathogen and Zheng Qi are mismatched, termed Fourth Reverse.

Cough, emaciation, body heat, and small/fast pulse constitute the Fifth Reverse. Emaciation and body heat indicate True Yin depletion and lingering Fire. Small, fine, fast pulse indicates Pathogen Excess and Zheng Qi Decline, constituting the Fifth Reverse.

Abdominal distension, cold extremities, severe diarrhea constitute the First Reverse. Abdominal distension fears Middle Deficiency most. Seeing cold extremities and severe diarrhea indicates Spleen Yuan failure and Yang departure, constituting the First Reverse.

Abdominal distension with bloody stool, pulse large and intermittent constitutes the Second Reverse. Distension and bloody stool are Yin diseases. Large, intermittent pulse indicates solitary Yang about to detach, constituting the Second Reverse.

Cough, hematuria, emaciation, and pounding pulse constitute the Third Reverse. Cough and hematuria indicate Qi and Blood disease. Emaciation indicates Spleen failure. Pounding pulse indicates True Zang appearance, indicating Stomach failure, constituting the Third Reverse.

Hematemesis, chest fullness radiating to back, large/fast pulse constitute the Fourth Reverse. Hematemesis and chest fullness radiating to back indicate Zang Qi connecting to the back. Fine/small pulse retains Yin; large/fast pulse indicates True Yuan depletion.

Cough, vomiting, abdominal distension, and Sundun Diarrhea with absent pulse constitute the Fifth Reverse. Such patients die within an hour. Upper: vomiting/reversal; Middle: abdominal distension; Lower: Sundun Diarrhea. San Jiao is diseased, and pulse is absent, indicating Pathogen without Zheng Qi. Physicians failing to observe this practice Reverse Treatment.