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When examining a patient's illness, one must simultaneously observe their facial complexion and physical form, then correlate these with the pulse and symptoms. If this is truly understood at the beginning, the prognosis can be determined accurately, resulting in no errors in a hundred cases. How is this known? If a Yin syndrome presents with Yang-colored signs, such as bright redness on the cheeks and zygomatic arches; or if a Yang syndrome presents with Yin-colored signs, such as cyanosis of the fingernails, both of these indicate death. Additionally, body heat with a fine pulse, lips and corners of the mouth turning blue, and fixed staring eyes indicate death. A face looking like it is coated with rouge, color resembling earthy yellow, or oily black qi smeared on the face indicates death. Dry and scorched lips and tongue, nose producing soot-like black deposits, and exposed spirit in the eyes indicate death. Emaciated appearance, dull and short-spirited demeanor, and shrunken body shape indicate death. Rapid and coarse breathing with shortness of breath, flaring nostrils, protruding eyes, and delirious speech indicate death. Grasping at clothes and bedrails, involuntary urination and defecation, and grasping at empty air (cuo kong) indicate death. Head drooping, neck weakness, spiritless eyes, and shallow, short breathing indicate death. Broken skin without bleeding, ruptured and ulcerated flesh with spots, and numbness without sensation of pain or itch indicate death. Teeth yellow like boiled beans, white lips with cracked textures, black and dry ears with hearing loss, shortened and flat philtrum, open mouth with exhaled air unable to close back, nasal flaring accompanying respiration, sweat beads that do not disperse, phlegm hardening like glue, blood that is white or red like lung tissue, curved nails with cyanosis, confused, floating, chaotic, or scattered spirit, black qi covering the face, and tragic black qi on the forehead—all these signs lead to death. The method for evaluating these lies herein.

The "Three Causes" refer to Internal Causes, External Causes, and Non-Internal/External Causes. This theory follows ancient precedents, though its meaning has not been fully expounded. Internal Causes originate from the stagnation of the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright) within, combined with the steaming of the Zang-Fu organs by rich and greasy foods, and the depletion of Yuan Qi due to excessive sexual activity and fatigue. These affect the Five Zang Organs, and diseases arising internally are most common among wealthy individuals and the obese, accounting for eight or nine out of ten. The presenting symptoms include ulcers that are hard with deep roots, irregular bowel movements and urination, poor appetite, soft exterior but hard interior, flat depression without pus, excess in the Exterior and deficiency in the Interior, and difficulty in expelling toxins. Such cases constitute internal injury within the disease pathology, hence termed "Internal Cause."

External Causes arise when the Six Excesses (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) invade those with deficient constitutions. Examples include sleeping outdoors in summer or autumn, cooling off in drafts, or sitting/sleeping on damp ground, leading to Wind-Cold-Dampness invading the meridians. It may also occur after sexual intercourse, where Cold-Toxin penetrates deeply into the bone marrow due to deficiency, coagulating with Qi and Blood, which is particularly severe. Or, external Wind pathogen invasion that is not fully dispersed leads to swelling and pain. These affect muscles, blood vessels, and sinews/bones. Diseases arising externally are most common among those who fail to regulate their lifestyle, living frugally and laboring heavily, accounting for eight or nine out of ten. Presenting symptoms often include alternating chills and fever, bone and joint pain, difficult walking, flowing toxic phlegm, various wind syndromes causing paralysis, deviation of the mouth and eye, hemiplegia, Wind-Dampness, Wind-Warmth, and epidemic toxic diseases. Such cases constitute external contraction in disease pathology, hence termed "External Cause."

There is also the Non-Internal/External Cause. If there is no internal disturbance by the Seven Emotions and no external injury by the Six Excesses, where does the disease come from? Such diseases result from irregular eating and drinking, overwork, frequent anger or joy, improper temperature of food and drink, and excessive labor without rest, leading to disharmony of the Zang-Fu organs, unsmooth Ying and Wei circulation, spleen and stomach injury, and meridian stagnation. Patients with such conditions present with no Six Channels symptoms externally and no obstruction of stool or urine internally. The disease typically arises between the fascia, muscle layers, and skin, resembling scrofula (luo li), phlegm nodules, Qi痞 (qi pi), or goiters (ying liu). Treatment should not involve releasing the Exterior or purging the Interior, but rather nourishing Qi and Blood, regulating meridians, strengthening the Spleen and harmonizing the Middle Jiao, moving phlegm, and resolving stagnation. This is the most appropriate method. Thus, the theory of the Three Causes is fully explained.