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Yang deficiency leads to external cold, yin deficiency leads to internal heat, yang excess leads to external heat, and yin excess leads to internal cold. Yang receives Qi from the Upper Jiao (Upper Burner) to warm the skin and muscles. If cold pathogen is outside, (it causes) the Upper Jiao to be obstructed; if the Upper Jiao is obstructed, cold pathogen remains alone on the exterior, thus causing chills and shivering. (This refers to: cold pathogen outside, yin-cold restraining Wei Qi (Defensive Qi), failing to warm the surface, while cold pathogen remains alone, manifesting as chills and shivering; this is the principle of "Yang deficiency leads to external cold".) If due to overexertion, the form and Qi decline, Gu Qi (Grain Qi) is insufficient, the Upper Jiao fails to circulate, and the Lower Wan (Lower Stomach) is blocked, stomach heat arises and steams the chest, thus causing internal heat. (Here, Xing Qi (Form Qi) refers to Yin Qi. Overexertion leading to Xing Qi decline damages Spleen Yin, causing stagnant heat to steam the chest; this is the principle of "Yin deficiency generates internal heat". Exertion damaging form mainly refers to the Spleen and Stomach. If emotional desires are unregulated, it damages the Essence of the Five Zang organs; essence damage leads to Kidney Water deficiency, so evil fire easily arises, making yin deficiency with internal heat even more severe.) If the Upper Jiao is not smooth, the skin becomes dense, Cou Li (interstices) close, Xuan Fu (pores) block, and Wei Qi cannot diffuse outward, thus causing external heat; (This refers to: external cold pathogen obstructing the Upper Jiao, muscle surface closing, Wei Qi stagnating without circulation generating external heat; as stated in "when people suffer from cold, they develop heat disease", this belongs to exogenous syndromes.) Jue Qi (Rebellious Qi) moves upward, cold pathogen accumulates in the chest without dissipating; without dissipation, warming Qi departs, cold remains alone, blood coagulates and becomes stagnant, vessels become blocked, the pulse is large and choppy, thus causing internal cold. (Here, Jue Qi refers to Cold-Jue Qi. Either cold pathogen damages Zang organs, or diet involves excessive cold food, cold stays in the Middle Jiao, Yang Qi departs, meridians stagnate, thus the pulse is large and choppy. Because Yang pulses are usually smooth, lack of smoothness indicates absence of Yang; this belongs to endogenous syndromes.)

When Qi is excess, the form is solid; when Qi is deficient, the form is weak; when Grain Qi is abundant, Qi is abundant; when Grain Qi is deficient, Qi is deficient; when the pulse is excess, Blood is excess; when the pulse is deficient, Blood is deficient. This is the normal state; deviation from this constitutes disease. (Form manifests externally, Qi nourishes internally; when form and Qi harmonize, it is called Peace. Thus, excess Qi results in a solid form, deficient Qi results in a weak form; this is the normal constitution. If form and Qi contradict each other, diseases of partial deficiency or excess arise. Humans obtain Qi from grain; grain enters the Stomach, transmits to the Lung, and all Five Zang and Six Fu organs receive Qi. This Qi born from grain is called "Gu Qi" (Grain Qi). Therefore, the abundance or scarcity of Gu Qi should correspond with Qi; non-correspondence indicates disease. The fullness or emptiness of the pulse is used to observe the deficiency or excess of Qi and Blood; thus, correspondence between pulse and Blood is normal, while non-correspondence is pathological.) What constitutes contradiction? Qi deficiency but body heat, Qi excess but body cold. (The following explains the above text. Qi deficiency implies Yang deficiency, which should present with body cold; presenting instead with fever indicates Yin Qi is deficient internally and Yang Qi is excessive externally, a contradictory phenomenon of form and Qi.) Eating much but having little Qi. (Eating much indicates excess in the Two Yang [Stomach/Intestines]; little Qi indicates insufficiency in the Three Yin.) Eating little but having much Qi. (Eating little indicates pathogen in the Stomach Fu; much Qi indicates involvement of the Lung. Pulse large but Blood deficient, pulse small but Blood abundant—this is called contradiction. (Pulse large/Blood deficient indicates Yang excess/Yin deficiency; pulse small/Blood abundant indicates Yang deficiency/Yin excess; both are termed "contradiction".) Qi excess with body cold results from contracting Cold Damage (Shang Han); Qi deficiency with body heat results from contracting Summerheat Damage (Shang Shu). (Qi excess/body cold from Shang Han means cold damages form; Qi deficiency/body heat from Shang Shu means summerheat damages Qi. People suffering from cold develop heat disease. Why is body cold associated with Shang Han and body heat with Shang Shu? One must know that Shang Han occurs in all four seasons, whereas Shang Shu occurs only in summer. After the Summer Solstice, some may contract both cold and summerheat simultaneously; one must carefully distinguish their Yin and Yang attributes. Generally, Yin pathogens entering the body cause cold to gather at the exterior and Qi to accumulate internally, so evil Qi is excess and the body feels cold due to cold; Summerheat pathogens entering the body cause heat to touch the exterior and Qi to be damaged internally, so healthy Qi is fatigued and the body feels hot without cold. This distinguishes summer cold and summerheat, hence mentioned together, not implying all Shang Han patients have cold without heat.) Eating much but having little Qi results from blood loss or dampness residing below. (Eating much indicates Stomach heat digesting food well. Blood loss means loss of Yin; dampness below indicates Spleen/Kidney insufficiency, also Yin deficiency. Yin deficiency leads to lack of Qi, so although eating is abundant, Qi is scarce.) Eating little and having much Qi indicates pathogen in the Stomach and Lung. (Pathogen in Stomach prevents eating, so intake is low; pathogen in Lung causes panting and fullness, so Qi is excessive.) Pulse small but Blood abundant indicates drinking alcohol or fluids with heat. (Pulse small suggests Blood should be deficient yet appears abundant; this must be due to heat in alcohol or drinks stirring it.) Pulse large but Blood deficient indicates Jue with Wind pathogen, and inability to take water or gruel. (Wind is a Yang pathogen residing in vessels, causing large pulse; inability to take fluids means Middle Jiao cannot generate, resulting in deficient Blood.)

Excess refers to Qi entering; deficiency refers to Qi exiting. (The following discusses causes of deficiency/excess/cold/heat to apply tonification/reduction methods. Qi entering fills the interior, constituting excess; Qi exiting leaks from the middle, constituting deficiency.) Qi excess is Heat; Qi deficiency is Cold. (Qi is Yang Qi; excess means Yang excess, thus Heat; deficiency means Yang deficiency, thus Cold.) There is also the saying that Five Excesses and Five Deficiencies lead to death. (Five Excesses refer to excess in the Five Zang; Five Deficiencies refer to deficiency in the Five Zang. If all Five Excesses or all Five Deficiencies are present, death ensues. However, death from extreme Qi deficiency is logically inevitable; why do Five Excesses also cause death? Wherever evil gathers, healthy Qi must be deficient; unless dying through evacuation, it ultimately returns to exhaustion of Qi. Yet deficiency and excess have true and false aspects, requiring careful differentiation.) Pulse surging, skin hot, abdominal distension, obstruction of urination and defecation, mental confusion and blurred vision—this is called "Five Excesses"; (Excess means evil Qi is surging. Surging pulse is governed by Heart; hot skin by Lung; abdominal distension by Spleen; obstruction of front and back relates to Kidney opening at two yin; confusion/blurred vision relates to Liver meridian piercing diaphragm with rebellious Qi in the middle. 'Mao' means unclear vision.) Pulse fine, skin cold, shortness of breath, diarrhea/incontinence of urine and stool, inability to eat—this is called "Five Deficiencies". (Deficiency means healthy Qi is deficient. Fine pulse indicates Heart deficiency; cold skin indicates Lung deficiency; shortness of breath indicates Liver deficiency; diarrhea/incontinence indicates Kidney deficiency; inability to eat indicates Spleen deficiency.) Among these, some survive: if gruel enters the Stomach and diarrhea stops, the deficient patient lives; (Treatment enabling gruel entry revives Spleen Qi gradually; stopping diarrhea consolidates Kidney Qi gradually. Root Qi returns, so deficient patients live.) Sweating occurs, and bowels/bladder open, then the excess patient lives. These are their signs. (Sweating resolves exterior pathogen; bowel/bladder opening eliminates interior pathogen. Interior and exterior harmonize, so excess patients live. Nowadays, few cases are excess; seven or eight out of ten are deficiency. Excess diseases come fast and go fast, so treatment is easy; deficiency injuries are gradual and hard to recover, so treatment is difficult. Excess affects robust individuals with new pathogens, allowing attack and removal; deficiency involves root depletion with sudden changes, warranting caution. Human deficiency stems from congenital insufficiency or acquired insufficiency. Congenital insufficiency arises from endowment, requiring extra caution and urgent postnatal nurturing to prolong life; ignoring it leads to premature death. Acquired insufficiency arises from labor and injury, requiring prompt awareness and regulation via emotion, medicine, and diet; delaying treatment leads to regret. Distinguishing Labor (Lao) and Injury (Shang): Lao damages Shen Qi (Spirit/Qi), such as joy, anger, worry affecting Heart, or sorrow/grief affecting Lung—all damaging Spirit/Qi. Shang damages Form, such as improper diet injuring Spleen, careless living injuring Liver, or sexual excess injuring Kidney—all damaging Form. Damaging Lung injures Qi, causing dry skin and brittle hair; damaging Heart injures Shen, causing scanty Blood failing to nourish Zang organs—this is top-down damage. Damaging Liver injures sinews, causing flaccidity and inability to control; damaging Kidney injures Essence, causing bone marrow depletion and weakness unable to rise—this is bottom-up damage. Damaging Spleen injures the foundation of granaries, causing food not transforming into flesh—this is mid-level damage. Heart/Lung damage ruins spirit and complexion; Liver/Kidney damage ruins form and causes wasting; Spleen/Stomach damage ruins digestion. Diseases of this type belong to the category of "Damage". Although damage divides among Five Zang, what they store is nothing but Essence and Qi. Essence is Yin, human Water; Qi is Yang, human Fire. When Water and Fire are correct, they become Essence and Qi; when imbalanced, they become Heat and Cold. Partial damage leads to partial excess. Thus, Water must contain Fire; without Fire, Yin prevails causing Cold. Fire must contain Water; without Water, Yang prevails causing Heat. Carefully distinguishing Yin and Yang leaves no gaps in treating deficiency-damage. For Water deficiency, greatly tonify True Yin, never again attack Yang Qi; for Fire deficiency, greatly tonify Original Yang, never again injure Yin Qi. Since Yang is already insufficient, attacking Yin further harms Yin; since Yin is already insufficient, attacking Yang further destroys Yang. Excess involves surplus Yin/Yang; removing the surplus restores balance. Deficiency involves lacking Yin/Yang; removing what remains leads to mutual failure, how can life be sustained? Therefore, the key to treating deficiency: for Yin deficiency with much heat, avoid pungent-dry herbs fearing aid to Yang evil; especially avoid bitter-cold fearing destruction of generating Yang Qi; prefer pure-sweet waters-nourishing formulas, tonifying Yin to match Yang, so Yang is controlled by Yin, deficient fire descends, and Yang returns to Yin. For Yang deficiency with much cold, avoid cool-moistening herbs fearing aid to Yin evil; especially avoid pungent-dispersing fearing injury to Yin Qi; use only sweet-warm fire-benefiting substances, tonifying Yang to match Yin, so Yin finds its master, deep cold敛 (conceals), and Yin follows Yang. Thus, Qi deficiency should be treated by tonifying the upper; Essence deficiency by tonifying the lower; Yang deficiency by tonifying with warmth; Yin deficiency by tonifying with clearing. This is the distinction in Yin-Yang treatment. If Qi is deficient due to Essence, naturally tonify Essence to transform Qi; if Essence is deficient due to Qi, naturally tonify Qi to generate Essence. Furthermore, if Yang separates from Yin, how else than tonifying Yin to gather scattered Qi? If Water fails due to Fire, how else than tonifying Fire to rescue sinking Yin? This is the subtle application of Yin-Yang mutual assistance. Therefore, those skilled in tonifying Yang must seek Yang within Yin, so Yang gains Yin's aid and generation is endless; those skilled in tonifying Yin must seek Yin within Yang, so Yin gains Yang's ascent and sources are inexhaustible. Thus, dividing Yin/Yang by Essence/Qi means Yin and Yang cannot separate; dividing by Cold/Heat means Yin and Yang cannot mix. This is the separation and union of Yin/Yang and Evil/Righteous. Knowing the treatment of Yin/Yang and Evil/Righteous leads to harmony of Yin/Yang and attainment of the Dao.)