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The origin of diseases encompasses ten forms: wind, cold, dryness, dampness, summerheat, and fire. These are categorized into internal and external injuries, internal and external accumulations, six qi (pathogenic factors) and four causes, thereby clarifying the pathogenesis.

When vital qi is solid and the physical form is robust, one resists pathogens; however, if the physical form is deficient and struck by wind pathogens, it may manifest as alternating chills and fever, or "Re Zhong" (Heat entering the interior), or "Han Zhong" (Cold entering the interior), or "Li Feng" (severe wind-induced disease), or "Pian Ku" (hemiplegia/paralysis of half the body). Such conditions are mostly associated with phlegm or blood deficiency. Lesions on the left side often indicate static blood (blood stasis), while those on the right side often indicate phlegm. In cases of severe phlegm obstruction causing facial paralysis (deviation of mouth and eyes) and aphasia, emetic therapy should be employed. For sudden collapse due to qi deficiency, descending phlegm and tonifying qi is indicated. If fire-heat is excessive, presenting as dry heat or tidal fever, treatment must follow the affected meridians. For yin deficiency, tonify yin; do not abruptly use cooling agents. Mild conditions can be treated with light dispersing methods, while excess conditions require purgation. Severe conditions are difficult to treat but may respond to contrary treatment (treating with methods opposite to the apparent symptoms). If struck by middle-cold or cold pathogens, leading to yin toxicity or yin reversal, with cold limbs, abdominal pain, and cyanotic lips, one must dispel yin and restore yang, urgently warming the middle jiao.

Diseases caused by Cold Damage (Shang Han) present in two main types: fever with aversion to cold, stiffness and pain in the head and neck, opisthotonos (arching of the back), trismus (lockjaw) with a red face, convulsions resembling epilepsy. With sweating, it is called "Rou Jing" (Flaccid Spasm); without sweating, it is called "Gang Jing" (Stiff Spasm). Injury by wind in spring leads to undigested diarrhea (Sun Xie) in summer; if additionally injured by summerheat, malaria occurs in autumn. Injury by dampness in autumn leads to cough in winter; injury by cold in winter leads to Warm Diseases (Wen Bing) in spring. In summer, body heat with sweating, aversion to cold, heaviness, faint pulse, and thirst indicates Heat Stroke (Zhong Shu). Warm diseases occurring in spring include Warm Epidemic, Warm Toxin, Warm Malaria, and Wind-Warmth; these five etiologies are distinguished by pulse and symptoms. Dampness and wind-dampness combine with summerheat to form Damp-Warmth. These three can be differentiated, as can dampness and heat. Cold-phlegm, beriberi (Hong Jiao), food stagnation, and labor-fatigue are four syndromes that resemble Cold Damage. However, Cold Damage may present with Wind Strike pulses, and Wind Strike may present with Cold Damage pulses. One must recognize formulas such as Da Qing Long Tang (Major Blue Green Dragon Decoction) and Xiao Qing Long Tang (Minor Blue Green Dragon Decoction) for treatment, balancing Wei (Defensive) and Ying (Nutritive) qi.

Malaria resembles Cold Damage and may be caused by phlegm or food stagnation. Chronic malaria forming a mass (Nu Mu) leads to emaciation over time. Malaria occurring every three days indicates a one-year duration; every other day indicates a six-month duration; daily occurrence indicates a new onset. Two consecutive days of fever followed by one day of remission indicates involvement of both qi and blood. Treatment may involve stopping malaria methods or treating according to the meridians. Coughs are often due to cold invasion and require differentiation of the six qi. The six qi originate from one root, which is the secret of pathogenesis. Wind-heat and cold are treated according to symptoms. Summerheat and dryness require clearing the Metal element (Lungs), while dampness requires promoting urination. Cough with sound but little phlegm differs from cough with phlegm, which is treated by descending and eliminating phlegm. Asthma may stem from qi deficiency, phlegm obstruction, or qi rebellion, sometimes requiring leaning forward to breathe. Dysentery originates from damp-heat or dietary indiscretion, presenting with abdominal pain, bloody stool, and tenesmus. Treatment involves draining and dispersing; avoid astringents while damp-heat persists, lest it become chronic dysentery (Xiuxi Li). Diarrhea is mostly due to dampness, but also heat, food stagnation, or qi deficiency. Spleen diarrhea presents with distension, vomiting, and uncontrollable watery stool; Intestine diarrhea involves pain and difficulty defecating with penile pain; Stomach diarrhea features yellow stool and undigested food. *Tai Su* classifies them into five types: loose stool, duck-like stool, undigested stool, and slippery stool. Obstruction at the Lanmen point requires treating excess based on syndrome.

Jaundice (Dan) is caused by damp-heat. Polydipsia (Xiao Ke) is caused by heat; edema is caused by qi dysfunction. Spontaneous sweating indicates yang deficiency; night sweats indicate yin deficiency. Li Dongyuan has methods for these, applied according to syndrome. Head wind and headache are often due to phlegm. Blood deficiency and heat are treated by meridian differentiation. Vertigo and dizziness are caused by fire accumulating phlegm or qi deficiency; treating phlegm is primary. Lower back pain is due to damp-heat, kidney deficiency, or blood stasis. Hypochondriac pain is mostly due to qi stagnation, liver fire, blood stasis, or phlegm migration. Consumption (Lai Zhai) is yin deficiency; mania and madness are excessive yang fire. Vomiting with slight epistaxis, with a large pulse, indicates fire carrying blood upward and erratic flow. Hematuria and hematochezia share similar causes. Nocturnal emission and spermatorrhea are caused by damp-heat invasion. Cloudy urine originates from heat, phlegm, or deficiency. White turbidity belongs to Wei level; red turbidity belongs to Ying level. Extreme heat causes strangury (Lin) due to qi stagnation. Blood deficiency causes palpitations; qi deficiency causes deafness. Hiccups stem from stomach disease; hernias originate in the Liver meridian. Flaccidity is solely due to damp-heat; qi weakness leads to insufficient nourishment. Reversal (Jue) is often due to phlegm-qi or deficiency-heat. Numbness in hands is qi deficiency; hand numbness/stiffness is damp-phlegm or blood stasis. Cholera with vomiting and diarrhea is caused by wind-dampness. Heart pain and spleen pain are attributed to yin-cold. Qi-heat and fatigue cause "Jian Jue" (Frying Reversal). Excessive qi rebellion causes "Bo Jue" (Thrusting Reversal). Turbid qi ascending causes distension; clear qi descending causes undigested diarrhea. Movement of yin-fire causes throat bi. Yang-water transformation leads to undigested diarrhea. Convergence of the three yang meridians causes chills and fever, lower body swelling, and flaccidity/reversal. Disease of the two yang meridians affects the heart and spleen, causing low sperm count in men and amenorrhea in women. Disease of the single yang meridian causes shortness of breath, cough, and diarrhea. Cold invading the upper jiao causes stomach cold and yang-heat, leading to indigestion, fullness, and diarrhea. Heat residing above and cold below causes rapid digestion with hunger, abdominal distension, and difficult bowel movements. Accumulated heat and depression generate various winds. Wind, cold, and dampness combine to form Bi syndrome. Changes from rich foods easily cause large carbuncles. When Ying qi does not flow smoothly and reverses internally, abscesses and swellings arise. Sores and ulcers are diagnosed by pulse, ensuring accurate treatment. Heavy body with slow pulse indicates dampness excess; treat by removing dampness. Body heat with large pulse indicates restless heat and swelling; treat by reducing heat and cooling Ying. Vertigo with tremors, pain with wiry pulse, requires descending phlegm and expelling wind. Qi stagnation and Wei obstruction with thirsty, choppy pulse require tonifying blood and draining qi. Poor appetite with aversion to cold and tight, thin pulse indicates cold-water excess; drain cold-water. Differentiate meridians and treat carefully. Damp-heat generates parasites; water accumulation and phlegm-fluid retention occur. Eye pain with redness and swelling indicates scattered essence and Ying heat. Toothache and swollen gums distinguish between cold and heat. Primary diseases of the five zang organs with heat contention lead to severe jaundice. Disharmony of the six fu organs leads to accumulation and abscesses. Disharmony of the five zang organs leads to obstruction of the nine orifices. Transmission between zang and fu organs creates endless variations. Transmission through intervening zang organs preserves life (transmitting to what it generates); seven-step transmission leads to death (transmitting to what controls it).

Accumulations in the five zang organs: Liver accumulation is called "Fei Qi," located under the left hypochondrium, size of an inverted cup, possibly with heads and feet; long-term it changes to cough, rebellion, and malaria, persisting for years. Heart accumulation is called "Fu Liang," starting above the navel, arm-sized, extending to the epigastrium; if untreated, it causes vexation. Spleen accumulation is called "Pi Qi," in the epigastrium, plate-sized; if untreated, limbs cannot move, turning into yellow jaundice, wasting despite eating. Lung accumulation is called "Xi Ben," under the right hypochondrium, cup-sized; if untreated, it causes panting, bone flaccidity, and shortness of breath. Drum distension and gu poisoning involve middle-fullness and depression; lifting qi and regulating ascending/descending is appropriate. The root of the human body is the Spleen and Stomach. Headache, tinnitus, and obstruction of the nine orifices are generated by the intestines and stomach. Deficiency of Stomach qi, when extreme, transforms into disease, with five disorders interacting. Li Dongyuan discussed: The Kingly Way of learning involves one deficiency and one excess, five excesses and five deficiencies. Five labors and seven injuries lead to the six extremes and flaccidity; five depressions and seven emotions are caused by nine qi movements. Anger causes qi to ascend; joy causes qi to slacken; grief causes qi to dissipate; fear causes qi to descend; cold causes qi to contract; summerheat causes qi to leak; shock causes qi to disorder; labor causes qi to consume; thought causes qi to knot. Worry and overthinking damage the Heart; cold form and cold drinks damage the Lungs; anger and qi rebellion damage the Liver; diet and labor fatigue damage the Spleen; sitting/lying in wet places or forcing entry into water damages the Kidney. All result from qi movement. Physical and spiritual illness arises from unregulated emotions. Labor damages the form and reverses qi, causing qi and blood imbalance. Yin and yang interact; yang invading yin causes yin disease, yin invading yang causes yang disease. Yang invasion brings heat; yin invasion brings cold. Extreme cold transforms to heat; extreme heat transforms to cold. Cold damages the form; heat damages qi. Qi damage causes disease; form damage causes swelling. Pain then swelling indicates qi damaging form; swelling then pain indicates form damaging qi.

Regarding yin-yang transformations and root/branch cold-heat: If severe cold is not relieved by heat, there is no fire; if heat comes and goes, appearing by day and hiding by night, moving with seasons, there is no fire; assist the Heart. If severe heat is not relieved by cold, there is no water; if heat moves and stops, coming suddenly and stopping intermittently, there is no water; assist the Kidney. Internal blockage with vomiting and inability to eat indicates fire; vomiting after eating indicates no fire. Sudden profuse diarrhea with undigested food indicates fire; chronic loose stools with irregular onset indicate no water. Excess heart generates heat; excess kidney generates cold. Again, heat without cold indicates no fire; cold without heat indicates no water. Failure to relieve cold with cold therapy blames lack of water; failure to relieve heat with heat therapy blames lack of fire. If heat relief is brief, blame heart deficiency; if cold relief is brief, blame kidney insufficiency. Examine pathogenesis, do not miss qi suitability, record in water and fire, and the rest of the qi can be known.

Women's diseases often involve leukorrhea (red and white), masses, and hernias, caused by qi and blood disorders. Amenorrhea or continuous bleeding, pain during menstruation, indicates deficiency with heat. Painful menstruation indicates blood excess; early periods indicate blood heat clotting; late periods indicate blood scarcity or exhaustion. Pale discharge indicates much phlegm; purple indicates heat; extreme heat turns black. Regulate Ying and descend fire. For pregnancy, clear heat and nourish blood. After childbirth, if no nausea/vomiting, greatly tonify qi and blood; treat other symptoms secondarily. Generally, children overheated by too much warmth develop heat; extreme heat generates wind; wind-phlegm and accumulated heat are treated according to the disease. Newborns may have fetal toxins,惊 (fright) within the month, redness, vomiting, or jaundice with constipation. Umbilical wind with mouth contraction, fever from transformation, wind-epilepsy, acute/chronic convulsions, convulsions with fright, palpitations with voidiness, sudden vomiting, abdominal distension with cough, evil invasion with upward gaze, goose-mouth tongue coating, wooden tongue, playing with tongue, guest fright with night crying, pus in ears/nose with caries, eyebrow dan lesions, scrotal swelling with cloudy urine, rotten tongue with bad breath, eroding tooth caries, worm pain with vomiting roundworms, malnutrition with fontanelle bulging, green stool with red cheeks, vomiting food/water, green/white vomit/diarrhea, deep sleep with exposed eyes, yawning with sallow face, grinding teeth, prolapse from diarrhea/dysentery, sores with hives, smallpox/chickenpox with macules, fright-malnutrition and various accumulations. Most diseases involve the Liver and Spleen meridians; diagnosis relies on pulse accuracy. Qian Yi's formula theories cover male and female conditions, diet, and daily life. Sudden joy followed by sorrow damages essence and qi. From wealth to poverty is called "Shi Jing" (Loss of Essence); from nobility to baseness, even without external pathogens, disease arises internally, called "Tuo Ying" (Depletion of Ying). The body diminishes daily, qi becomes deficient, and essence is lost. Skilled physicians must not miss this. Pulse, disease, syndrome, and treatment allow knowing the subtle signs to cure early. Examples of abdominal pain classics and yin syndrome treatments are mentioned by Hai Zang, secrets of profound mysteries.