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The "Four Dimensions" (Siwei) refer to the four limbs. "Xiangdai" (mutual succession/replacement) refers to swelling occurring successively in these areas. The four limbs are where the Qi of all Yang meridians is abundant. Successive swelling indicates that the Qi is deficient and its movement is irregular, hence it is said that "Yang Qi is exhausted."

The *Suwen: Yuji Zhenzang Lun* states: If the Spleen pulse is excessive, it causes inability to move the four limbs; if it is deficient, it causes obstruction of the nine orifices. The *Lingshu: Benshen* chapter states: When Spleen Qi is deficient, the four limbs cannot be used; when Spleen Qi is excess, abdominal distension and difficulty in urination and defecation occur. Generally, when Spleen Qi is deficient, Ying and Wei Qi are depleted and cannot transport Qi to the four limbs, resulting in immobility; when Spleen Qi is excess, Ying and Wei Qi are obstructed and also fail to transport Qi to the four limbs, resulting in immobility. The same applies to the nine orifices. These two classics discuss this from complementary perspectives to exhaustively explain pathological variations.

If the Stomach pulse is firm and long, and the complexion is red, one should suffer from pain in the thigh as if broken. This occurs when Stomach Earth Qi is excessive, and Fire further exacerbates it, causing solitary flourishing of Fu Yang and injury to Zang Yin, leading to thigh pain resembling a fracture.

Turbid body fluids may result from the failure to transform grain Qi in the Spleen meridian, with damp-heat flowing downward; or they may result from the decline of Lung Metal Qi, causing stagnation and coagulation of urine. The Lung governs the Qi transformation of the "Zhou Du" (bladder/urinary reservoir). When Middle Qi is insufficient, urination and defecation become abnormal. One must not rigidly apply treatment based solely on the phrase "all belong to heat."

Juyang (Greater Yang/Taiyang) governs Qi and thus is the first to receive pathogenic factors. Shaoyin (Lesser Yin) is interior-exterior paired with it. When heat enters, it follows upward, leading to Jue (reversal/cold extremities). Thus, even minor wind-heat ailments can present with a red face and cold feet. In such cases, resolving exterior pathogens requires calming internal Qi. If only exterior-releasing medicines are used, True Yang will escape outwardly. Hence, it is stated that both exterior and interior points should be needled, and decoctions should be administered.

Jian Jue (Decoction Jue) is synonymous with Re Jue (Heat Jue). Fire forces downward while Qi rebels upward, causing reversal with irritability and heat. The condition deteriorates rapidly like a breached dam, vast and unstoppable, indicating that spirit and essence are scattered and ruined, akin to collapsing earth or overflowing water, irretrievable and uncontainable.

If the Heart pulse is deficient, it causes mental restlessness, upper symptoms of coughing and expectoration, and lower symptoms of Qi leakage. "Qi leakage" means Qi escapes with stool. Diseases of the Spleen and intestines, known as Qi Li (Qi diarrhea), arise from insufficient Fire affecting Earth.