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The human body is not constantly in a state of warmth, nor is it constantly in a state of cold. When heat arises accompanied by vexation and fullness, (because this is not the body's original constant state, it is termed "abnormal".) This occurs due to insufficient Yin Qi and an excess of Yang Qi, resulting in heat and vexation/fullness. (When Yin is deficient, Yang inevitably encroaches. When pathogenic Yang is excessive in the Yin aspect, it causes heat and vexation/fullness.)

The body does not feel cold merely from lack of clothing, nor is there internal cold generated within. (Cold generated from within refers to cold arising internally without external causative factors.) Such individuals often have Bi Qi (obstructive Qi). Because Yang Qi is scarce and Yin Qi is abundant, the body feels cold as if emerging from water. (Bi refers to the stagnation of healthy Qi. With little Yang and much Yin, Ying and Wei Qi cannot fill and reach the extremities, so cold generates from within; this belongs to the category of Cold Bi.)

Some individuals experience heat in the four limbs, feeling as if being moxibustioned or burned when encountering wind and cold. (Whenever there is internal heat constrained externally by wind and cold, the internal heat must become even more intense, hence the sensation of burning or moxibustion.) This indicates deficient Yin Qi and excessive Yang Qi. The four limbs belong to Yang; when two Yangs combine while Yin Qi is deficient, it is like a small amount of water failing to extinguish a raging fire, leading to Yang dominating exclusively. (The four limbs are the root of all Yang meridians. Wind also belongs to Yang. Heat in the four limbs combined with external wind constitutes "two Yangs combining." Given the deficiency of Yin, water cannot overcome fire, thus the pathology manifests as Yang dominating exclusively; "dominating" here means flourishing.) "Exclusive domination" implies an inability to generate and nourish; it is merely solitary hyperactivity. (Solitary Yang domination is isolated Yang, thus unable to generate and nourish, manifesting only as heat.) Encountering wind with sensations of burning or moxibustion indicates that the person's flesh will emaciate. (Flesh belongs to Yin. Excess Yang injures Yin, causing muscle emaciation.)

Some individuals suffer from body coldness that cannot be warmed by hot drinks or fire, nor by thick clothing, yet they do not shiver. This is because Kidney Qi was originally strong, but through excessive sexual activity ("engaging in water affairs"), the Taiyang Qi has declined, and Kidney essence/fluid is dried up and fails to grow. One water cannot overcome two fires. The Kidney belongs to Water and generates bone; if the Kidney fails to function, marrow will not fill, resulting in cold penetrating to the bone. (Those with originally strong Kidney Qi likely indulged excessively, damaging Kidney essence until fluid/essence dries up. Taiyang is the exterior of Shaoyin, Yang within Yin. Excessive desire damages Kidney essence, leading to dried-up essence where water cannot overcome fire. Fire excess further depletes Kidney Water, leaving marrow unfilled and Qi dried internally, causing cold to reach the bone.) The reason for not shivering is that the Liver is one Yang, the Heart is two Yangs, and the Kidney is a solitary organ; one water cannot overcome two fires, hence no shivering. This disease is named "Bone Bi," and such individuals should expect joint contracture. (The Liver contains Shaoyang Ministerial Fire, the Heart is Shaoyin Sovereign Fire, and the Kidney is one Water. With one Water exhausted and two Fires remaining, Yin is deficient internally while floating Yang dominates externally. Thus, although bones feel cold, shivering does not occur. Named "Bone Bi," since water cannot overcome fire, tendons and bones lose nourishment, leading to joint contracture.)

When a person's muscles feel heavy and numb, still feeling heavy even near cotton wadding, what disease is this? (He represents a sense of heaviness and numbness. He, pronounced 'he'.) This is due to deficient Ying Qi and solid/excess Wei Qi. Deficient Ying Qi leads to anesthesia (loss of sensation); deficient Wei Qi leads to paralysis (loss of movement); if both Ying and Wei are deficient, there is both anesthesia and paralysis, while the muscles remain unchanged. If the body and spirit are disconnected, it is termed "death." (Anesthesia means insensitivity to pain, itching, cold, and heat. Paralysis means inability to move. Ying Qi is Yin, governing the interior; Wei Qi is Yang, governing the exterior. The earlier mention of "solid Wei Qi" referred to the muscles themselves being unaffected; the later mention of "deficient Wei Qi" specifically addressed Wei Qi pathology. When both Ying and Wei are deficient, blood and Qi are both diseased; blood deficiency causes anesthesia, Qi deficiency causes paralysis. The body is external, the Five Wills are internal. Even if muscles appear normal, if Spirit/Qi loses its residence, the exterior has form but the interior lacks a master, appearing disconnected, thus leading to death.)

There are diseases involving heat accompanied by pain. Diseases with heat present involve Yang pulses, due to the activity of the Three Yang meridians. (Yang pulse indicates Fire pathogen. All heat diseases stem from Yang, hence the Three Yang pulses beat vigorously.) If the Renying pulse is one-fold larger, the disease is in Shaoyang; two-folds larger, in Taiyang; three-folds larger, in Yangming. It enters the Yin. (Renying is the artery of the Foot-Yangming Stomach meridian, used to observe Yang. One-fold enlargement indicates disease in Foot-Shaoyang Gallbladder; if rapid/agitated, Hand-Shaoyang Sanjiao. Two-folds indicates Foot-Taiyang Bladder; if agitated, Hand-Taiyang Small Intestine. Three-folds indicates Foot-Yangming Stomach; if agitated, Hand-Yangming Large Intestine. Once pathogenic heat traverses the Three Yang at the exterior, it enters the Yin aspect.) Since Yang enters Yin, the disease affects the head and abdomen, causing abdominal distension and headache. (Head governs Yang, Abdomen governs Yin. Yang pathogen in the head causes headache; upon entering Yin, the abdomen becomes distended.)

There are conditions where cold and heat transfer between the Zang and Fu organs. (Transfer means the disease moves from one organ to another.) If Kidney transfers cold to Spleen, carbuncles/swellings and shortness of breath occur. (Kidney cold transferring to Spleen causes carbuncles. Carbuncles can result from both cold and heat. Heat constitutes Yang toxin, cold constitutes Yin toxin. Spleen governs flesh; cold causes Qi to gather and harden. Hardness without dispersion results in swelling or carbuncle. "Carbuncle" implies obstruction. Kidney's cold water energy retrogressively attacks the conquered Spleen Earth, causing obstructive edema. Shortness of breath occurs because severe cold causes lower Jiao Yang deficiency, preventing Qi transformation.) If Spleen transfers cold to Liver, carbuncles and tendon spasms occur. (Spleen cold excess transfers to Liver. Spleen cold chills the flesh, causing carbuncles. Liver cold chills the tendons, causing spasms.) If Liver transfers cold to Heart, mania and chest obstruction occur. (Liver cold transferring to Heart is transmission to the generated organ. Heart governs Fire and houses Spirit. Receiving Liver's counter-flow cold disrupts Spirit, causing mania. Heart vessels connect to the heart system and pass through the diaphragm; Yang suppressed by Yin prevents Qi flow, causing cold obstruction in the chest.) If Heart transfers cold to Lung, Lung Xiao (Lung Consumption) occurs. In Lung Xiao, drinking one part results in urinating two parts; this is incurable and fatal. (Heart and Lung are both Yang organs. Heart transferring cold to Lung indicates decline of Sovereign Fire. Insufficient Fire fails to warm Lung Metal; unwarmed Lung Qi cannot transform fluids, so one drink yields double urine. Lung is the mother of Water; excessive fluid loss exhausts Lung Qi, hence "Lung Xiao." Loss of gatekeeping and daily depletion of Yuan Essence lead to death.) If Lung transfers cold to Kidney, Yong Shui (Gushing Water) occurs. In Yong Shui, pressing the abdomen reveals no hardness; water Qi lodges in the Large Intestine, making a gurgling sound when walking quickly, resembling a bag containing watery fluid. (Yong Shui is water surging upward like a spring. Water is Yin Qi, rooted in Kidney, ending in Lung. Lung cold transferring to Kidney prevents Yang Qi transformation below; untransformed Yang leads to water flooding as pathogen lodging in Large Intestine, which is the Interior-Exterior pair of Lung. Abdominal softness with intestinal gurgling confirms the diagnosis.)

If Spleen transfers heat to Liver,惊 (startle/fright) and epistaxis occur. (Previous text discussed "transferring cold"; this discusses "transferring heat." Spleen heat transferring to Liver is counter-transmission to the conquering organ, indicating intense heat. Liver stores Blood; pathology involves fright. Pathogenic heat provokes Wind-Fire interaction, causing startle and nosebleed.) If Liver transfers heat to Heart, death ensues. (Heart inherently belongs to Fire; Liver transferring Wind-Heat creates Wood-Fire combustion, attacking the Sovereign Organ, leading to death.) If Heart transfers heat to Lung, it transmits to Ge Xiao (Diaphragm Consumption). (Lung belongs to Metal, naturally dry. Heart transferring heat increases dryness, transmitting to Ge Xiao. Ge Xiao involves upper jiao vexation, excessive thirst, and rapid consumption. Earlier, Lung Xiao was caused by cold; here, Ge Xiao is caused by heat, showing Xiao Ke has Yin and Yang types requiring differentiation.) If Lung transfers heat to Kidney, it transmits to Rou Ji (Soft Spasm). (Rou means weak/tender tendons. Ji means stiff bones. Lung governs Qi, Kidney governs Bone. Heat in both Lung and Kidney consumes True Yin daily, transmitting to Rou Ji. Ji, pronounced 'chi'.) If Kidney transfers heat to Spleen, it transmits to Xu Chang Pi (Deficiency Intestinal Dysentery), which is fatal and incurable. (Kidney heat transferring to Spleen is Ministerial Fire flaring upward. Lower pathogenic heat depletes True Yin, causing deficiency. Kidney is Water organ but harasses Spleen with heat, causing bloody/purulent diarrhea. Yin deficiency counter-attacking leads to collapse of Water and Earth, hence fatal.) If Bao Gong (Uterus/Womb) transfers heat to Bladder, Long (difficulty urinating) and hematuria occur. (Bao Gong is uterus; in males, Jing Shi; in females, Xue Shi. Bladder is the mansion of fluids,俗称 "Su Pao". Mingmen Fire excess causes Bao Gong heat to transfer to Bladder, causing dysuria (Long) or hematuria. Commonly seen with reckless Ministerial Fire causing obstruction. Bao, Bao, Pao have different pronunciations. In "Bao Tai" it is 'bao'; in "Su Pao" it is 'pao'.) If Bladder transfers heat to Small Intestine, ge chang bu bian (diaphragmatic/intestinal obstruction) and kou mi (oral ulceration/mucosal erosion) occur above. (Bladder heat ascending transfers to Small Intestine. Small Intestine vessels follow the throat, pass through diaphragm, reach stomach, branch to neck/cheek. Heat causes obstruction/stagnation in diaphragm/intestines and oral mucosal erosion in throat/cheeks.) If Small Intestine transfers heat to Large Intestine, Zha (masses) and Chen (deep masses) occur. (Small Intestine heat descending transfers to Large Intestine. Heat accumulation persists, Qi or Blood stagnates in convoluted areas, forming Zha/Zhi masses. Zha implies hidden/deep masses difficult to retrieve. Zha/Fu share meaning.) If Large Intestine transfers heat to Stomach, polyphagia with emaciation occurs, called "Shi Yi". (Large Intestine heat transferring to Stomach is dry-heat ascending, promoting grain digestion. Yangming governs flesh; heat scorches it, causing eating yet wasting, hence "Shi Yi".) If Stomach transfers heat to Gallbladder, it is also called "Shi Yi". (Stomach Yangming heat transferring to Gallbladder combines Wood-Fire, failing to generate Spleen Earth, causing polyphagia and emaciation.) If Gallbladder transfers heat to Brain, Xin Bi Yuan (stinging nasal sinusitis) occurs. Bi Yuan is continuous discharge of turbid mucus. (Gallbladder vessels originate at outer eye corner, ascend to head angle, descend behind ear, spread around brain. Gallbladder heat transferring to brain causes stinging Bi Yuan. Xin means pungent/acrid. Yuan, pronounced 'e', refers to nasal cartilage.) Transmission leads to Nu Mie (nosebleed) and ming mu (blindness/dazzled eyes). (Unrelenting brain heat transmits to these symptoms. Nu and Mie are both nosebleeds; severe is Nu, mild is Mie. Heat injuring Yin blood deprives eyes of nourishment, causing dazzled eyes/unability to open due to photophobia. Mie, pronounced 'mie'.)

Thus, all these arise from Qi Jue. (Jue means Qi reversal. This summarizes the chapter: all result from Qi reversal.)

If an infant suffers from heat disease and the pulse is suspended and small, survival depends on warm hands and feet; cold hands and feet indicate death. (Infant with heat and suspended-small pulse presents Yang syndrome with Yin pulse, generally a major contraindication. However, small and slow indicates mild pathogen, easy recovery; small and rapid indicates severe pathogen, concerning. Infants have tender Yang bodies; heat disease should not present small pulse. If pulse is small but hands/feet are warm, since limbs are root of Yang, Yang remains, so life; if limbs cold, pathogen overcomes Zheng, Yuan Yang departs, so death. Warmth follows, coldness opposes.) If infant contracts Wind-Heat with wheezing and shoulder breathing, pulse should be substantial and large. Slow pulse indicates life; rapid pulse indicates death. (This addresses pediatric exterior contraction. Wind-Heat invading Yang causes wheezing/shoulder breathing, requiring substantial-large pulse. Large-slow indicates Stomach Qi remains, pathogen receding, so life; substantial-rapid indicates True Zang pulse appearing, disease progressing, so death. Ancient physicians emphasized pulse diagnosis in infants, even newborns. Why do later pediatric texts like *Shui Jing Jue* and *Quan You Xin Jian* rely solely on observing the Three Passages (San Guan) and ignore pulses? San Guan are superficial collaterals of Hand-Yangming, insufficient for observing Zang-Fu Qi. In infants, regardless of illness, these pulses are purple-white mixed with cyan-red, varying in intensity but always coexisting. How to distinguish purple as Wind, red as Cold, cyan as Fright, white as Malnutrition? Or specific fright types? Modern practitioners accept this habitually, ignoring pulse diagnosis, making crisis rescue impossible. No ancient texts mention "Three Passages"; only observing color at hand fish (Thenar eminence) is similar, but this is general diagnosis, not exclusive to pediatrics. Thus, San Guan theory is a later heterodoxy, unreliable. To diagnose infants, one must observe Qi Kou pulse, facial color, respiration sound, or optionally hand fish color. Infant pulses differ from adults; simplicity is key. Distinguishing Large/Small, Slow/Rapid, Deficient/Substantial covers all. Accurate diagnosis yields quick results, clear and easy, superior to other methods.)