夫百病之生也，皆生于风、寒、暑、湿、燥、火，以之化之变也。（气之正者为化，气之邪者为变，
故曰“之化之变”也。）盛者泻之，虚者补之，审察病机，无失气宜。（病随气动，必察其机，治
之得要，是无失也。）诸风掉眩，皆属于肝；（风类不一，故曰“诸风”。掉，摇也。眩，运也。风主动摇，
木之化也，故属于肝。其虚其实，皆能致此。如发生之纪，其动掉眩巅疾；厥阴之复，筋骨掉眩之类者，肝
之实也。又如阳明司天，掉振鼓栗，筋痿不能久立者，燥金之盛，肝受邪也；太阴之复，头顶痛重而掉螈
尤甚者，木不制土，湿气反胜，皆肝之虚也。下虚则厥，上虚则眩，实者宜凉宜泻，虚则宜补宜温。反
而为之，祸不旋踵矣。余治仿此。掉，提料切。）诸寒收引，皆属于肾；（收，敛也。引，急也。肾属水，
其化寒。凡阳气不达则荣卫凝聚，形体拘挛，皆收引之谓。如太阳之胜为筋肉拘苛，血脉凝泣。岁水太过为
阴厥，为上下中寒。水之实也；岁水不及为足痿清厥，涸流之纪，其病癃闭，水之虚也。水
之虚实，皆本于肾。）诸气 郁，皆属于肺；（ ，喘急也。郁，痞闷也。肺属金，其化燥。燥金盛则清邪
在肺而肺病有余，如岁金太过，甚则喘咳逆气之类是也；金气衰则火邪胜之而肺病不足，如从革之纪，其发喘
咳之类是也。肺主气，故诸气 郁者，其虚其实，皆属于肺。 ，音愤。）诸湿肿满，皆属于脾；（脾属土，
其化湿，土气实则湿邪盛行，如岁土
太过，则饮发中满食减，四肢不举之类是也。土气虚则风木乘之，寒水侮之∶如岁木太过，脾土受邪，民病
肠鸣，腹支满，卑监之纪，其病留满痞塞；岁水太过，甚则腹大胫肿之类是也。脾主肌肉，故诸湿肿满等症，
虚实皆属于脾。）诸热瞀螈，皆属于火；（瞀，昏闷也，螈，抽掣也。邪热伤神则瞀，亢阳伤血则螈，故皆
属于火，然岁火不及，则民病两臂内痛，郁冒蒙昧；岁火太过则民病身热、烦心、躁悸、渴而妄冒，此又火
之所以有虚实也。）诸痛痒疮，皆属于心；（热甚则痛，热微则痒。心属火。其化热，故疮疡皆属于心也。
然赫曦之纪，其病疮疡，心邪盛也；太阳司天，亦发为痈疡，寒水胜也。火盛则心实，水胜则心虚，于此
可见。）诸厥固泄，皆属于下；（厥，逆也。厥有阴阳二证∶阳衰于下，则为寒厥；阴衰于下，则为热厥。
固，前后不通也。阴虚则无气，无气则清浊不化，寒闭也；火盛则水亏，水亏则精液干涸，热结也，泄，二阴
不固也。命门火衰，则阳虚失禁，寒泄也；命门水衰，则火迫注遗，热泄也。下，肾也。盖肾居五脏之下，
为水火阴阳之宅，开窍于二阴，故诸厥固泄，皆属于下。）诸痿喘呕，皆属于上；（痿有筋痿、脉痿、骨痿、
肉痿之辨，故曰“诸痿”。凡肢体痿弱，多在下部，而曰“属于上”者，如五脏使人痿者，因肺热叶焦，发
为痿 也。肺居上焦，故属于上。气急曰喘，病在肺也。吐而有物有声曰“呕”，病在胃口也。逆而不降，
是皆上焦之病。）诸禁鼓栗，如丧神守，皆属于火；（禁，噤也。寒厥切牙曰“禁”，鼓，鼓颔
也。栗，战也。凡病寒战，而精神不能主持，如丧失神守者，皆火之病也。然火有虚实之辨，若表里热甚而
外生寒栗者，所谓热极生寒，重阳必阴也。心火热甚，亢极而战，反兼水化制之，故为寒栗者，皆言火之实也。
若阴盛阳虚而生寒栗者，阳虚畏外寒，阴胜则为寒，寒则真气去，去则虚，虚则寒搏于皮肤之间，皆言火
之虚也，有伤寒将解而为战汗者，其人本虚，是以作战。有 疟之为寒栗者，疟之发也，始则阳并于阴，既
则阳复阴仇，并于阳则阳胜，并于阴则阴胜，阴胜则寒，阳胜则热，更寒更热，
更实更虚也。由此观之，可见诸禁鼓栗，虽皆属火，必有虚实之分耳。）诸痉项强，皆属于湿；（痉，风强病
也。项为足之太阳，湿兼风化，而侵寒水之经，湿之极也，然太阳所至，为屈伸不利；太阳之复，为腰 反
痛，屈伸不便者，是又为寒水反胜之虚邪矣。痉，音敬。）诸逆冲上，皆属于火；（火性炎上，故诸逆冲
上者，皆属于火。然诸脏诸经，皆有逆气，则其阴阳虚实有不同矣，其在心、脾、胃者，太阴所谓“上走
心为噫”者。阴盛而上走于阳明，阳明络属心，故曰“上走心为噫”也。有在肺者，肺苦气上逆也；有在
脾者，足太阴厥气上逆，则霍乱也；有在肝者，肝脉若搏，令人喘逆也；有在肾者，少阴所谓“呕咳上气喘
者，阴气在下，阳气在上，诸阳气浮，无所根据从”也；有在奇经者，如冲脉为病，逆气里急，督脉生病，
从少腹上冲心而痛，不得前后为冲疝也。凡此者，皆诸逆冲上之病，虽诸冲上皆属于火，但阳盛者火之实，
阳衰者火之虚，治分补泻，于此详之。）诸胀腹大，皆属于热；（热气内盛者，在肺则胀于上，在脾
胃则胀于中，在肝肾则胀于下。此以火邪所至，乃为烦满，故曰“诸胀腹大，皆属于热”。如岁火太过，民
病胁支满；少阴司天，肺 ，腹大满，膨膨而喘咳；少阳司天，身面 肿，腹满仰息之类，皆实热也。然岁
水太过，民病腹大胫肿；岁火不及，民病胁支满，胸腹大，流衍之纪，其病胀。水郁之发，善厥逆，痞坚
腹胀。太阳之胜，腹满食减；阳明之复，为腹胀而泄。又如适寒凉者胀，脏寒生满病，胃中寒则胀满，是皆言
热不足，寒有余也。腹满不减，减不足言，须当下之，宜与大承气汤，言实胀也；腹胀时减，复如故，此为
寒，当与温药，言虚胀也，治此者，不可不察也。）诸躁狂越，皆属于火；（躁，烦躁不宁也。狂，狂乱也，越，
失常度也。热盛于外，则肢体躁扰；热盛于内，则神志燥烦。盖火入于肺则烦，火入于肾则躁。烦为热之轻，
躁为热之甚耳。如少阴之胜，心下热，呕逆躁烦；少阳之复，心热躁烦；便数憎风之类，是皆火胜之躁也，然
有所谓阴躁者，如岁水太过，寒气流行，邪害心火，民病心热、烦心、躁悸、阴厥、
谵妄之类，阴之胜也，是为阴盛发躁，名曰“阴躁”。凡内热而躁者，有邪之热也，病多属火；外热而躁者，
无根之火也，病多属寒，此所以热躁宜寒，阴躁宜热也。狂，阳病也。邪入于阳则狂，重阳者狂，如赫曦之纪，
血流狂妄之类，阳狂也。然复有虚狂者，如悲哀动中则伤魂，魂伤则狂妄不精；喜乐无极则伤魄，魄伤则狂。
狂者意不存人，阳重脱者阳狂，石之则阳气虚，虚则狂，是狂亦有虚实，补泻不可误用也。）诸暴强直，皆属
于风；（暴，猝也。强直，筋病，强劲不柔和也，肝主筋，其化风。风气有余，如木郁之发，善暴僵仆之类，
肝邪实也；风气不足，如委和之纪，其动 戾拘缓之类，肝气虚也。此皆肝木本气之化，故曰“属风”，非外来
虚风、八风之谓，凡诸病风而筋为强急者，正以风位之下，金气乘之，燥随风生，其燥益甚，治宜补阴以制阳，
养营以润燥，故曰∶“治风先治血，血行风自灭。”此最善之法也。设误认为外感之邪，而用疏风愈风等剂，
则益燥其燥，非惟不能去风，而适所以致风矣。）诸病有声，鼓之如鼓，皆属于热；（鼓之如鼓，胀而有声也。
为阳气所逆，故属于热。然胃中寒则腹胀，肠中寒则肠鸣飧泄，中气不足，肠为之苦鸣，此又皆寒胀之有声
者也。）诸病 肿，疼酸惊骇，皆属于火；（ 肿，浮肿也。 肿疼酸者，阳实于外，火在经也。惊骇不
宁者，热乘阴分，火在脏也。故如少阴、少阳司天，皆为疮疡、 肿之类，是火之实也。然伏明之纪，其
发痛；太阳司天为 肿，身后痈；太阴所至为重 肿；太阳在泉，寒复内余则腰尻、股胫、足膝中痛之类，
皆以寒湿之胜，而为肿为痛，是又火之不足也。至于惊骇，虚实亦然，如少阴所至为惊骇，君火盛也；若委和
之纪，其发惊骇；阳明之复，亦为惊骇，此又以木衰金胜，肝胆受伤，火无生气，阳虚所致，当知也。）
诸转反戾，水液混浊，皆属于热；（诸转反戾，转筋拘挛也。水液，小便也。热气燥烁于筋，则挛螈为痛，火
主燔灼，燥动故也。小便混浊者，天气热则水混浊，寒则清洁，水体清而火体浊故也；
又如清水为汤，则自然浊也，此所谓“皆属于热”，宜从寒者是也。然其中
亦各有虚实之不同者，如伤暑霍乱而为转筋之类，宜用甘凉调和等剂清其亢烈之火者，热之属也；如感冒非
时风寒，或因豪雨之后湿毒中脏而为转筋霍乱，宜用辛温等剂理中气以逐阴邪者，寒之属也。大抵热胜者必多
烦躁焦渴，寒胜者必多厥逆畏寒。故太阳之至为痉；太阳之复为腰 反痛，屈伸不便，水郁之发为大关节不利。
是皆阳衰阴胜之病也。水液之浊，虽为属火，然思虑伤心，劳倦伤脾，色欲伤肾，三阴损亏者多有是病，又
中气不足，溲便为之变，则阴阳盛衰，又未可尽为实热。）诸病水液，澄澈清冷，皆属于寒；（水液者，
上下所出皆是也。水体清，其气寒，故凡或吐或利，水谷不化而澄澈清冷者，皆得寒水之化，如秋冬寒冷，水必
澄清也。）诸呕吐酸，暴注下迫，皆属于热。（胃膈热甚则为呕，火气炎上之象也，酸者，肝木之味也，由火
盛制金，不能平木，则肝木自甚，故为酸也。暴注，卒暴注泄也。肠胃热甚而传化失常，火性疾速，故如是
也。下迫，后重里急。迫，痛也。火性急速而能燥物故也。是皆就热为言，亦属暴病故耳。或有属虚，属寒，
属湿，又当久病，宜临病而察之，不可扪 以为日也。）谨守病机，各司其属。有者求之，无者求之，
盛者责之，虚者责之。必先五胜，疏其血气，令其调达而致和平。（上文一十九条，即病机也。机者，要也，
变也，病变所由出也。凡或有或无，皆谓之机。有者言其实，无者言其虚，求之者，求有无之本
也。夫大寒而甚，热之不热，是无火也，当助其心。大热而甚，寒之不寒，是无水也；热动复止，倏忽往来，
时动时止，是无水也，当助其肾。内格呕逆，食不得入，是有火也；病呕而吐，食入反出，是无火也。暴速
注下，食不及化，是无水也；溏泄而久，止发无恒，是无水也。故心盛则生热，肾盛则生寒。肾虚则寒动于
中，心虚则热收于内。又热不得寒，是无水也；寒不得热，是无火也。夫寒之不寒，责其无水；热之不热，
责其无火。热之不久，责心之虚；寒之不久，责肾之少。有者泻之，无者补之，虚者
补之，盛者泻之，适其中外。疏其雍塞，令上下无碍，气血通调，则寒热
自和，阴阳调达矣。是以方有治热以寒，寒之而火食不入；攻寒以热，热之而昏躁以生。此则气不疏通，雍而
为是也，纪于水火，余气可知，故曰∶“有者求之，无者求之，盛者责之，虚者责之。”令气通调，妙之道
也。五胜，谓五行更胜也。先以五行，寒暑温凉湿、酸咸甘辛苦相胜为法也。）
The generation of all diseases arises from Wind, Cold, Summer-heat, Dampness, Dryness, and Fire (Six Qi), resulting from their normal transformation (Hua) and abnormal changes (Bian). (The normal state of Qi is called Hua, while the pathological state is called Bian; hence the term "Zhi Hua Zhi Bian".) For excess conditions, use draining methods; for deficiency conditions, use tonifying methods. Examine the pathogenesis carefully and do not deviate from the appropriateness of Qi dynamics. (Diseases follow the movement of Qi; one must investigate its mechanism to grasp the key to treatment and avoid errors.)
All wind-related tremors and dizziness belong to the Liver. (Wind varies in type, thus referred to as "all winds." 'Diao' means trembling; 'Xuan' means vertigo. Wind has a moving quality, corresponding to the transformation of Wood, hence it belongs to the Liver. Both Liver deficiency and excess can cause this. For instance, during the Ji of Generation, manifestations include tremors, vertigo, and head disorders; during the reversal of Jueyin, symptoms like tendon and bone tremors indicate Liver excess. Conversely, when Yangming governs the year, shaking, shivering, tendon flaccidity, and inability to stand long result from excessive Dry Metal attacking the Liver; during the reversal of Taiyin, severe headache with heavy sensation and pronounced tremors/spasms indicate Liver deficiency due to Wood failing to control Earth and Dampness prevailing. Deficiency in the lower Jiao leads to Jue (reversal cold/heat); deficiency in the upper Jiao leads to vertigo. Excess requires cooling and draining; deficiency requires tonifying and warming. Reversing this approach leads to immediate disaster. Other treatments follow this principle. 'Diao' is pronounced 'ti liao qie'.)
All cold-related contraction and pulling belong to the Kidney. ('Shou' means contraction/restriction; 'Yin' means urgency/tightness. The Kidney belongs to Water, whose transformation is Cold. When Yang Qi fails to penetrate, Ying and Wei Qi stagnate, causing body cramping, known as contraction. For example, excess Taiyang causes muscle stiffness and blood stasis. Excessive Water year运 leads to Yin Jue and internal cold (Water excess); deficient Water year运 leads to foot flaccidity and cold Jue, or urinary retention in the Ji of Drying Up (Water deficiency). Both Water excess and deficiency originate in the Kidney.)
All Qi-related asthma and stifling belong to the Lung. (' ,' refers to rapid breathing/asthma; 'Yu' means stifling/fullness. The Lung belongs to Metal, whose transformation is Dryness. Excessive Dry Metal brings clear pathogens to the Lung, causing Lung excess, such as wheezing and coughing with rebellious Qi in years of excessive Metal; if Metal Qi declines, Fire pathogens prevail, causing Lung deficiency, such as wheezing in the Ji of Transformation. The Lung governs Qi; thus, all Qi-related asthma and stifling, whether deficiency or excess, belong to the Lung. ' ,' is pronounced 'fen'.)
All dampness-related edema and fullness belong to the Spleen. (The Spleen belongs to Earth, whose transformation is Dampness. Earth excess leads to prevalent Dampness, such as fluid retention, abdominal fullness, reduced appetite, and limb immobility in years of excessive Earth. Earth deficiency allows Wind-Wood to invade and Cold-Water to insult: e.g., excessive Wood year affects Spleen Earth causing bowel sounds and abdominal distension; in the Ji of Low Supervision, disease involves stagnation and blockage; excessive Water year causes abdominal swelling and leg edema. The Spleen governs muscles; thus, all dampness-related edema and fullness, regardless of deficiency or excess, belong to the Spleen.)
All heat-related stupor and spasms belong to Fire. ('Mao' means stupor/confusion; 'Yuan' means convulsion/spasm. Pathogenic Heat damages Spirit causing stupor; hyperactive Yang damages Blood causing spasms, hence both belong to Fire. However, deficient Fire year causes pain in inner arms and mental cloudiness; excessive Fire year causes fever, vexation, palpitations, thirst, and delirium, illustrating Fire's deficiency and excess.)
All pain, itching, and sores belong to the Heart. (Intense Heat causes pain; mild Heat causes itching. The Heart belongs to Fire, whose transformation is Heat, so sores belong to the Heart. In the Ji of Blazing Sun, sores indicate Heart pathogen excess; during Taiyang governance, carbuncles may arise due to Cold-Water overcoming Fire. Fire excess indicates Heart excess; Water overcoming Fire indicates Heart deficiency.)
All Jue (reversal) and solid/loose excretions belong to the Lower Jiao. ('Jue' means reversal. There are two types: Yang deficiency below causes Cold Jue; Yin deficiency below causes Heat Jue. 'Gu' refers to obstruction of urination and defecation. Yin deficiency leads to lack of Qi, failure to transform clear and turbid, causing cold closure; Fire excess depletes Water, drying fluids and causing heat binding. 'Xie' refers to incontinence. Mingmen Fire deficiency causes Yang deficiency incontinence (cold diarrhea); Mingmen Water deficiency causes Fire forcing leakage (heat diarrhea). The Lower Jiao refers to the Kidney. Located below the five Zang organs, it is the residence of Water and Fire, Yin and Yang, opening into the two yin orifices. Thus, all Jue and excretory disorders belong to the Lower Jiao.)
All Wei (flaccidity), panting, and vomiting belong to the Upper Jiao. (Wei includes tendon, vessel, bone, and muscle flaccidity. Although limbs often weaken in the lower body, it is said to "belong to the Upper" because organ-induced Wei stems from Lung Heat scorching leaves. The Lung resides in the Upper Jiao. Panting indicates Lung pathology. Vomiting with sound and matter originates at the stomach gate. Rebellious Qi failing to descend characterizes Upper Jiao diseases.)
All locked jaws, chattering teeth, and shivering, resembling loss of spiritual control, belong to Fire. ('Jin' means locked jaw; 'Gu' means chattering teeth; 'Li' means shivering. Diseases with chills where spirit cannot maintain control are Fire diseases. Fire has deficiency and excess. External chills with internal intense heat represent extreme Heat generating Cold (Yang transforming to Yin). Extreme Heart Fire causing shivering via Water counter-reaction indicates Fire excess. Chills due to Yin excess and Yang deficiency indicate Fire deficiency. Shaking sweat during resolving Cold Damage indicates underlying deficiency. Malaria chills involve alternating Yin/Yang excess/deficiency. Thus, while these symptoms belong to Fire, one must distinguish deficiency from excess.)
All spasms and neck stiffness belong to Dampness. (Spasm is a wind-strong disease. The neck is traversed by the Foot-Taiyang channel. Dampness combined with Wind invades the Cold-Water channel, representing extreme Dampness. Taiyang excess causes limited flexion/extension; Taiyang reversal causes back arching pain and difficulty moving, indicating deficiency evil from Cold-Water counter-attack. 'Jing' is pronounced 'jing'.)
All rebellious Qi rushing upward belong to Fire. (Fire nature is flaming upward, so rebellious Qi belongs to Fire. However, various organs/channels have rebellious Qi differing in Yin/Yang and deficiency/excess. In Heart/Spleen/Stomach, Taiyin describes "rising to Heart as belching" due to Yin excess rising to Yangming, which connects to Heart. In Lung, Qi rebels upward. In Spleen, Jue Qi rebellion causes Huoluan. In Liver, pulsating pulse causes panting/rebellion. In Kidney, Shaoyin describes vomiting/coughing/panting due to floating Yang lacking root. In extraordinary vessels, Chong Mai disease causes rebellious Qi and urgency; Du Mai disease causes Qi rushing from lower abdomen to heart with pain and obstruction (Chong Hernia). All these rebellious upward conditions belong to Fire, but Yang excess indicates Fire excess, while Yang deficiency indicates Fire deficiency. Treatment distinguishes tonification and draining.)
All distension and abdominal enlargement belong to Heat. (Internal Heat excess causes distension in Upper Jiao (Lung), Middle Jiao (Spleen/Stomach), or Lower Jiao (Liver/Kidney). Caused by Fire pathogen leading to vexation/fullness, it is attributed to Heat. Examples include胁肋 fullness in excessive Fire years, lung congestion/abdominal distension/panting in Shaoyin governance, and facial/body swelling/abdominal fullness in Shaoyang governance (all excess heat). However, excessive Water years cause abdominal/leg swelling; deficient Fire years cause chest/abdominal distension; Ji of Overflowing Waters causes distension. Water depression causes厥逆/bloating. Taiyang excess causes abdominal fullness/reduced appetite; Yangming reversal causes abdominal distension/diarrhea. Exposure to cold causes distension; visceral cold causes fullness; stomach cold causes bloating (indicating insufficient Heat/excess Cold). Unrelenting abdominal fullness requires purgation (Da Cheng Qi Tang) for excess distension; intermittent fullness returning to normal indicates cold, requiring warming herbs for deficiency distension. Careful examination is essential.)
All restlessness, mania, and deviation from normal behavior belong to Fire. ('Zao' is restless agitation; 'Kuang' is madness; 'Yue' is deviation. External Heat excess causes limb agitation; internal Heat excess causes mental vexation. Fire entering Lung causes vexation; Fire entering Kidney causes restlessness. Vexation is mild Heat; restlessness is severe Heat. Shaoyang excess causes heart heat/vomiting/restlessness. However, "Yin Restlessness" occurs in excessive Water years where Cold harms Heart Fire, causing heart heat/vexation/palpitations/Yin Jue/delirium. Internal heat with restlessness usually indicates Fire pathogen; external heat with restlessness indicates rootless Fire (often Cold). Mania is a Yang disease. Evil entering Yang causes mania (e.g., blood flow madness in Blazing Sun year). Deficient mania exists: grief injuring Hun causes madness; excessive joy injuring Po causes madness. Yang depletion causes Yang mania. Stone therapy depletes Yang, leading to deficiency mania. Mania has deficiency/excess; tonification/draining must not be misapplied.)
All sudden rigidity belong to Wind. ('Bao' means sudden. Rigidity is a tendon disease, stiff and unyielding. Liver governs tendons, transforming into Wind. Excess Wind, like Wood depression eruption, causes sudden collapse (Liver excess). Deficient Wind, like Ji of Gentle Harmony, causes deformity/limpness (Liver deficiency). This reflects Liver Wood's intrinsic transformation, termed "belonging to Wind," distinct from external wind. For wind diseases with tendon rigidity, Metal conquers below Wind, generating Dryness. Treatment should nourish Yin to control Yang and nourish Ying to moisten Dryness: "Treat wind by treating blood first; when blood moves, wind extinguishes." Misdiagnosing as external pathogen and using dispersing wind formulas exacerbates Dryness and generates wind.)
All diseases with sounds, drum-like upon percussion, belong to Heat. (Drum-like sound indicates distension with noise caused by rebellious Yang, hence Heat. However, stomach cold causes abdominal distension; intestinal cold causes borborygmus/sundew diarrhea; middle Qi deficiency causes painful bowel sounds (cold distension with sound).)
All diseases with edema, pain/aching, and fright belong to Fire. ('Zhong' swelling is edema. Pain/aching in swelling indicates Yang excess externally, Fire in channels. Fright/restlessness indicates Heat invading Yin divisions, Fire in organs. Shaoyin/Shaoyang governance causes sores/edema (Fire excess). However, Ji of Hidden Brightness causes pain; Taiyang governance causes posterior carbuncles; Taiyin causes heavy edema; Taiyin in泉 with residual Cold causes waist/thigh/knee pain (Cold-Damp excess, Fire deficiency). Fright also varies: Shaoyin causes fright (Minister Fire excess); Ji of Gentle Harmony/Yangming reversal cause fright (Wood deficiency/Metal excess damaging Liver/Gallbladder, Fire lacking life force, Yang deficiency).)
All twisting, arching, and turbid fluids belong to Heat. (Twisting/arching refers to tendon spasms. Fluids refer to urine. Heat drying tendons causes spasms/pain (Fire burns, Dryness moves). Turbid urine resembles hot water becoming cloudy (Fire is turbid, Water is clear). Treatment should cool. However, deficiency/excess varies. Summerheat Huoluan with spasms requires sweet-cool harmonizing agents (Heat). Non-seasonal Cold/Wind or post-rain damp-toxin Huoluan requires pungent-warm agents to regulate middle Qi and expel Yin evil (Cold). Heat excess causes vexation/thirst; Cold excess causes Jue/cold aversion. Taiyang arrival causes spasm; Taiyang reversal causes back pain/stiffness; Water depression causes joint stiffness (Yang deficiency/Yin excess). Turbid urine, though Fire-related, also arises from Heart/Spleen/Kidney damage from worry/fatigue/excess sex, or middle Qi deficiency affecting urination. Yin/Yang balance must be considered, not just excess Heat.)
All diseases with clear, cold fluids belong to Cold. (Fluids refer to all discharges. Water is clear and cold. Vomiting/diarrhea of undigested food that is clear and cold reflects Cold-Water transformation, like clear water in autumn/winter.)
All vomiting of acid, sudden profuse diarrhea, and tenesmus belong to Heat. (Stomach/esophagus Heat causes vomiting (Fire flaming up). Sour taste is Liver Wood flavor; Fire excess controls Metal, failing to subdue Wood, causing Wood excess and sourness. Sudden profuse diarrhea results from intestinal/stomach Heat disrupting transmission (Fire is swift). Tenesmus (heavy feeling/urgency) is due to Fire's speed and drying nature. These describe acute Heat diseases. However, some cases are deficiency, cold, or damp, especially chronic ones. Clinical observation is necessary; do not rigidly apply rules.)
Closely observe the pathogenesis and determine its affiliation. Investigate what is present and what is absent. Address excess and deficiency accordingly. First understand the Five Phases' mutual overcoming, then unblock Qi and Blood to restore harmony. (The previous nineteen clauses constitute the pathogenesis. 'Ji' means essence and change, the source of disease variation. Presence indicates excess; absence indicates deficiency. Investigation seeks the root. Severe cold unresponsive to heat indicates lack of Fire; tonify Heart. Severe heat unresponsive to cold indicates lack of Water; tonify Kidney. Intermittent heat indicates Water deficiency. Internal rejection/vomiting preventing intake indicates Fire presence. Vomiting after eating indicates Fire absence. Sudden watery diarrhea indicates Water deficiency. Chronic loose stools indicate Water deficiency. Heart excess generates Heat; Kidney excess generates Cold. Kidney deficiency causes internal cold; Heart deficiency causes internal heat retention. Cold unresponsive to heating indicates Water deficiency; Heat unresponsive to cooling indicates Fire deficiency. Brief response to heat indicates Heart deficiency; brief response to cold indicates Kidney deficiency. Drain excess, tonify deficiency. Unblock obstructions to allow free flow of Qi and Blood, harmonizing Cold/Heat and Yin/Yang. If cooling fails and food is rejected, or heating fails and causes confusion/agitation, it is due to blocked Qi. Understanding Water/Fire applies to other Qi. Hence: "Investigate presence/absence, address excess/deficiency." Unblocking Qi is the subtle way. 'Wu Sheng' refers to the mutual overcoming of Five Phases, using Cold/Hot/Warm/Cool/Damp and Sour/Bitter/Sweet/Pungent/Salty as methods.)