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The commentary states: Cold in the intestines and stomach leads to dysfunction of transmission and transformation. According to the Five Elements theory, the child element (Metal) controls the "ghost thief" (Wood), thereby strengthening the self (Earth). Consequently, cold prevails while Fire declines and Metal prospers, resulting in vomiting and diarrhea with a fishy odor. The fishy smell is the odor associated with Metal; thus, heat syndromes present with sour-smelling vomit and diarrhea, whereas cold syndromes present with fishy-smelling vomit and diarrhea. This is analogous to food and liquids: when heated, they tend to become sour; when cooled, they retain a watery, fishy scent.

The commentary states: Yin Water governs purity and clarity. Therefore, in cold diseases, the four limbs become cold and reversed, accompanied by stiffness and rigidity, making extension and flexion difficult. Hence, the winter pulse is deep, short, and robust, which is the manifestation of disease. If the cold pathogen is slight and has not yet progressed to reversal cold (Jue Ni), it should not be mistaken for heat; conversely, if extreme heat causes Yang Reversal (Yang Jue), it should not be mistaken for a cold disease. However, the pulse signs of Yin Reversal belong entirely to Yin syndromes, characterized by a cool body, absence of thirst, and a slow, fine, and faint pulse, none of which appear in Yang syndromes. In contrast, the pulse and symptoms of Yang Reversal belong entirely to Yang syndromes, characterized by extreme heat manifesting as reversal cold, occasional return of warmth, irritability, thirst, delirium despite cold extremities, fever, and a rapid pulse. If Yang Reversal is extremely severe, leading to a cold body and a pulse that appears Yin and nearly imperceptible, this indicates that extreme heat is approaching death. The Classic states: "The alternation of one Yin and one Yang constitutes the Dao; deviation toward Yin or Yang constitutes disease." Yin and Yang achieve harmony through balance and disease through deviation. All things are born carrying Yin and embracing Yang; thus, isolated Yin cannot grow, and solitary Yang cannot form. Therefore, when Yang Qi is extremely excessive and Yin Qi is extremely deficient, Yang Qi becomes constrained and stagnant. Due to the imbalance between Yin and Yang, their circulation fails, causing Yang Qi to accumulate internally rather than circulate to the four limbs, resulting in cold hands and feet known as Yang Reversal. Zhang Zhongjing stated: "The deeper the heat, the deeper the reversal; the slighter the heat, the slighter the reversal." He also stated: "Reversal syndromes should be treated with purgation; after purgation, the reversal resolves." One should use cooling herbs to nourish Yin and subdue Yang, such as using Liang Ge San (Cool the Chest Powder) or Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction) to purge. Generally, in treating diseases, one must first clarify the Biao (Branch/Surface) and Ben (Root/Origin). Biao refers to the superficial manifestations, while Ben refers to the root cause. Thus, the Classic states: "The primary disease is the Root; the secondary disease is the Branch." It further states: "When Root and Branch transmit to each other, treat the urgent condition first." It also says: "The Six Qi are the Root; the Three Yin and Three Yang meridians are the Branch." Therefore, the pathogenic factor is the Root, and the affected meridians and organs are the Branch. Regarding the severity of Root and Branch, treatment must employ contrary (Ni) or following (Cong) methods, which requires thorough understanding. Thus, the Classic states: "Knowing contrary and following methods allows correct practice without doubt; clearly understanding Root and Branch ensures success in every attempt; failing to understand Root and Branch is termed reckless action." This is precisely what is meant.