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The commentary states: "Ku" (withered) refers to the loss of nourishment and flourishing; "He" (dried up) refers to the absence of body fluids; "Gan" (dry) refers to lack of moistening; "Jin" (stiff/tough) refers to a lack of softness.
(However), spring and autumn are opposite because dryness and dampness differ [thus]. The general principle states: Fever on the body surface indicates heat in the exterior; thirst with desire to drink water indicates heat in the interior;
fever accompanied by thirst indicates heat in both the interior and exterior; cool body without thirst indicates no heat in either the interior or exterior. The classics do not solely attribute thirst to the transformation of Fire, stating that thirst is not exclusively due to [heat]; for instance, in [illnesses involving] cold patterns with vomiting and diarrhea, if body fluids are excessively depleted, dryness and thirst will also occur; even in wind-heat illnesses, if body fluids have not yet declined, there will be [no] thirst. How can one simply say that thirst signifies heat, while palpable masses signify cold?

The commentary states: Cracking of the skin. Heaven corresponds to the Qian trigram, symbolizing Dry Metal; Earth corresponds to the Kun trigram, symbolizing Damp Earth. Heaven and Earth are opposite, and Dryness and Dampness function differently,
(thus) Dry Metal governs contraction [and gathering], hence the pulse in autumn is tight, fine, and slight; (while) Damp Earth governs relaxation and laxity, hence in the sixth month its pulse is slow, large, and long. Just as wet ground is relaxed, slippery, and lustrous, while dry ground is contracted, gathered, dry, and [rough], the principle of skin cracking is clear. Popular opinion attributes cracking to Wind, because Wind overcomes Dampness, thereby creating Dryness. The classics state: Where Jueyin Liver Wind prevails, it manifests as the Wind Mansion and as cracks (skin fissures), due to Wind overcoming Dampness to create Dryness.
Cold belongs to Taiyang Cold Water, which is the Qi mechanism of the Kidney and Bladder.
[All diseases where fluids discharged from above and below are clear, cold, and pure; abdominal masses, hernias, palpable masses, hardness, abdominal distension with urgent pain, profuse watery white diarrhea, feeling no hunger after eating, vomiting and diarrhea with fishy/foul odors, difficulty in flexing and extending limbs, cold extremities with stiffness and immobility, all belong to Cold.]

The commentary states: Clear and tranquil, not turbid. Water nature is pure and clear, and its Qi is cold; therefore, food and fluids fail to transform, resulting in clear and cold vomiting and diarrhea, making fluid disorders manifestations of Cold. Just as when the weather is cold, turbid water naturally clarifies.

The commentary states: Hardness in the abdomen, which offers resistance upon pressure, is called [Pi] (palpable mass). Water nature is soft and compliant, but now it appears hard like the earth; this is because excess leads to harm, and balance is maintained through counter-control. ([Thus, when illness-dampness] becomes extreme and results in [Pi], it paradoxically incorporates the mechanism of Wind transformation to control it.) When Wind pathology becomes extreme and paradoxically shows Dryness, causing tendons and vessels to become stiff, it paradoxically incorporates the mechanism of Metal transformation to control it. When Dryness pathology becomes extreme causing irritability and thirst, it paradoxically incorporates the mechanism of Fire transformation to control it. When Heat pathology becomes extreme and paradoxically produces the five fluids, or presents with shivering and aversion to cold, it paradoxically incorporates the mechanism of Water transformation to control it. In treating these conditions, one should use [draining] methods to remove the excessive Qi, addressing the root cause of the disease, rather than mistakenly treating the paradoxical transformations. The Way of the Five Constants dictates that if something becomes too strong without restraint, creation ceases. For example, in Spring, Wood is prosperous and Wind is abundant; if Wind is excessive, it paradoxically turns cool, which is Metal transformation controlling Wood. Under great cold, the weather paradoxically warms, which is Fire transformation receiving and controlling Metal. In Summer, when Fire heat is extreme, the body paradoxically sweats and produces fluids, which is Water transformation controlling Fire. Thus, dampness steams into clouds and rain, which is Earth transformation receiving Water. When rain and dampness become excessive and are accompanied by [fierce] wind, Wood transformation controls Earth. Under sudden [heavy] rains, Autumn Qi paradoxically cools, which is Metal transformation receiving Wood.
When cold becomes extreme and paradoxically shows Dryness, it is Fire transformation controlling Metal. Thus, [Winter Cold forms], which is Water transformation receiving Fire. When Cold is extreme, Water [freezes] like the earth, which is Earth transformation controlling Water. Extreme freezing gives rise to East Wind, which is [Wood] transformation receiving Earth to complete the year.
Anyone who does not understand the root and branch of diseases does so because they do not know (this way of transformation).