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The pulse is floating and rapid, the patient can eat, but there is no bowel movement; this is called Yang Jie (Yang Knotting), and the condition will likely worsen on the seventeenth day. The pulse is deep and slow, the patient cannot eat, the body feels heavy, and the stool is conversely hard; this is called Yin Jie (Yin Knotting), and the condition will likely worsen on the fourteenth day. Generally, the Qi of Heaven and Humanity changes every fifteen days; upon change, the knotting should resolve. If it does not resolve, the disease will become severe. The mention of the seventeenth day refers to Yang Jie where the patient can eat, thus exceeding the period; the mention of the fourteenth day refers to Yin Jie where the patient cannot eat, thus falling short of the period. Cheng Wuji’s theory regarding the "secondary transmission of knotting" is overly rigid and inaccurate.

In Shanghan (Cold Damage), with abdominal fullness and delirium, if the Cun Kou (Cun position at the radial artery) pulse is floating and tight, this is Liver Wood overacting on Spleen Earth, named Zong (Vertical/Longitudinal), treated by needling Qimen (LR14). In Shanghan, with fever, shivering aversion to cold, extreme thirst desiring water, inevitable abdominal fullness, spontaneous sweating, and free urination, this is Liver Wood overacting on Lung Metal, named Heng (Horizontal/Lateral), treated by needling Qimen (LR14). Regarding abdominal fullness and delirium, the pulse should be solid and deep, yet it is floating and tight; this indicates not interior excess-heat, but Liver Pathogen invading the Spleen, causing Qi obstruction resulting in an apparent excess syndrome. Regarding fever and aversion to cold, the pathology is in the exterior, where thirst is not typical, yet extreme thirst occurs; this indicates not internal heat, but Liver Pathogen invading the Lungs, causing Qi stagnation leading to dryness. Since there is no heat in the interior to consume fluids, abdominal fullness results; however, sweating and free urination indicate that Lung Qi has already circulated, hence recovery. Both conditions resolve by draining the Liver Pathogen; failing to recognize this and attacking apparent excess-heat would be a mistake. Such variations in pathogenesis must be carefully examined.

When Pathogenic Qi enters and Righteous Qi is suppressed, disease occurs; when Righteous Qi recovers and Pathogenic Qi retreats, sweating occurs and health is restored. However, if Pathogenic Qi is not yet strong enough to immediately cause illness, and Righteous Qi is still weak and unable to immediately overcome the Pathogen, this is why trembling and shivering occur.
When Pathogenic Qi contends outwardly with Righteous Qi, it manifests as Zhan (Trembling/Shivering); when it contends inwardly with Righteous Qi, it manifests as Li (Shuddering/Fearful Trembling). Li refers to inner heart palpitations and fearfulness. The Classics state: "If Yin is invaded by Pathogens, there must be inner shuddering." If it is Zhan, only the limbs tremble and shake. In cases of Zhan, Righteous Qi prevails, often leading to resolution through sweating. In cases of Li, interior Qi is deficient and unable to resist the Pathogen, eventually leading to Jue (Cold Extremities) and Tuo (Collapse).