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All pathogenic factors must have a cause, and the location where the disease is contracted varies. Contemporary physicians often state: "Treatment must be based on distinguishing the meridians." This seems plausible; however, do they also realize that diseases are not entirely confined to what can be explained by meridians? The human body possesses skin, flesh, tendons, and bones to form its structure, which is referred to as the "body shell" (Qiao Ke). Within this hollow interior, Zang-Fu organs (viscera) reside to fill it. Connecting and penetrating through these structures are the Jing (Meridians) and Luo (Collaterals), which run within the Zang-Fu organs and throughout the body shell, serving as pathways for the circulation and transformation of Qi and Blood. Therefore, when pathogenic factors invade the human body, they may affect the skin and flesh, the tendons and bones, the Zang-Fu organs, or the meridians. Some conditions transmit to other areas, while others do not; some transmit after a long period, while others never transmit despite the passage of time. The general principle is that diseases affecting the meridians are prone to transmission; those initially not in the meridians, or those severe enough to spread into the meridians, are also prone to transmission. If meridian diseases penetrate deeply into the Zang-Fu organs, they transmit according to the Five Elements generation and restriction cycles. Only diseases located in the skin, flesh, tendons, and bones that do not involve the meridians will not transmit; these are termed "diseases of the body shell." Thus, a skilled physician should clearly identify the specific Zang, Fu, tendon, bone, meridian, or collateral involved, determine whether transmission will occur, and trace the starting and ending meridians of any transmission. If such diagnoses are clear and verifiable, the physician is considered enlightened. Today's practitioners, regardless of the actual disease, arbitrarily cite a single meridian as an excuse to appear knowledgeable about the *Huangdi Neijing* (Yellow Emperor's Inner Canon); this demonstrates a complete misunderstanding of the text. Regarding treatment difficulty, diseases in the meridians are easier to treat, whereas diseases in the Zang-Fu organs are difficult to treat and often fatal. Diseases in the skin, flesh, tendons, and bones are difficult to treat but less likely to result in death. These are the general rules. As for determining acupuncture and herbal therapy methods based on which meridians govern the body shell and Zang-Fu organs, the *Huangdi Neijing* states this explicitly, and deep study yields understanding.

To know the ease or difficulty of treating a disease, one must first know its depth. To know the depth, one must first know its location. Although the human body is a unity, there are distinct differences between exterior/interior and upper/lower. What constitutes the Exterior? It is the skin, flesh, tendons, and bones. What constitutes the Interior? It is the Zang-Fu organs and Spirit (Shen). The meridians penetrate between them. Diseases in the Exterior are easier to treat and less likely to be fatal; diseases in the Interior are difficult to treat and more likely to be fatal. This is the general overview. However, both Exterior and Interior diseases have varying degrees of difficulty, so one cannot apply a rigid rule. If a disease originates in the Exterior but transmits to the Interior, or originates in the Interior and simultaneously affects the Exterior, this is called "combined Exterior-Interior disease," which is particularly difficult to treat. Diseases in the upper half of the body tend toward Heat; diseases in the lower half tend toward Cold. This is the general rule. Yet, both Upper and Lower regions can present with either Cold or Heat patterns, so again, one cannot generalize rigidly. If a disease originates in the Upper part but transmits to the Lower, or originates in the Lower and transmits to the Upper, this is called "combined Upper-Lower disease," which is also difficult to treat. The reason is that if healthy areas outnumber diseased areas, vital energy (Jing-Qi) can still maintain balance, allowing Zheng Qi (Upright Qi) to gradually strengthen and eliminate Xie Qi (Pathogenic Qi). However, if the entire body is diseased, what serves as the foundation for expelling pathogens and restoring Yuan Qi (Original Qi)? Therefore, superior physicians, recognizing that intense pathogenic forces inevitably transmit, take preventive measures beforehand: preventing stagnation, preventing spreading, and preventing consolidation. This aligns with the concept of "treating disease before it arises" advocated by Shang Gong (Superior Physicians). If transmission has already occurred, one must first address the root (Ben) and then the branch (Biao), applying treatment according to the urgency of the condition. This represents remedial action after the fact. By applying these principles to judge the prognosis and difficulty of diseases, one has grasped the majority of the essential concepts.