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Cold and heat are the transformations of Yin and Yang. When Yin is insufficient, Yang takes advantage of it, resulting in heat; when Yang is insufficient, Yin takes advantage of it, resulting in cold. Therefore, an excess of Yin damages Yang, and an excess of Yin constitutes a cold syndrome. An excess of Yang damages Yin, and an excess of Yang constitutes a heat syndrome. Extreme heat generates cold phenomena due to the severity of heat; extreme cold generates heat phenomena due to the severity of cold. Yang deficiency leads to external cold, as cold inevitably damages Yang; Yin deficiency leads to internal heat, as heat inevitably damages Yin. Yang excess leads to external heat, as Yang belongs to the Yang aspect (exterior); Yin excess leads to internal cold, as Yin belongs to the Yin aspect (interior). Cold damages the form (referring to the exterior), while heat damages Qi (referring to the interior). Thus, during periods of vigorous Fire, there is an excess of Yang and heat diseases arise; during seasons of vigorous Water, there is an insufficiency of Yang and cold diseases arise. Diseases caused by human activities stem from the interior, while diseases caused by climatic interactions stem from the exterior. One must understand the exterior-interior distinction of cold and heat, and one must not fail to differentiate their deficiency-excess nature.

First, heat located in the exterior manifests as fever and headache, as erysipelas swelling and yellowish rashes, as removing clothes and blankets, and as various painful sores and ulcers.

Second, heat located in the interior manifests as mental confusion, chest tightness, and abdominal fullness, as irritability, thirst, asthma, and constipation, or as rapid breathing with shouting, or as restlessness and mania.

Third, heat located in the upper part manifests as headache and red eyes, as throat sores and toothache, as various rebellious Qi rushing upward, as a preference for cold drinks and a black tongue coating.

Fourth, heat located in the lower part manifests as swelling and pain in the waist and feet, as difficult and scanty urination and defecation, or as painful seminal emission accompanied by heat, or as turbid urine and reddish stool.

Fifth, cold located in the exterior manifests as aversion to cold, as a cold body, as edema, as a blueish and miserable facial complexion, and as cold and cold-convulsion of the four limbs.

Sixth, cold located in the interior manifests as a cold throat and intestinal rumbling, as nausea and vomiting, as heart and abdominal pain, and as aversion to cold with a preference for warmth.

Seventh, cold located in the upper part manifests as acid regurgitation, as dysphagia (difficulty swallowing), as indigestion of food, as belching with a rotten smell, abdominal distension, and hiccups.

Eighth, cold located in the lower part manifests as the failure to distinguish between clear and turbid substances, as loose stools with abdominal pain, as impotence, as urinary enuresis, and as cold knees and cold feet.

Ninth, if a patient has a high fever but desires to cover up with clothes, the heat is at the skin level (superficial) while the cold is in the bone marrow (deep); if a patient feels very cold but does not desire to cover up, the cold is at the skin level (superficial) while the heat is in the bone marrow (deep). This is the differentiation of exterior syndromes. However, severe internal heat often presents with aversion to cold; this should be examined by combining pulse findings with clinical manifestations.

Tenth, the pulse of true cold must be slow, weak, and lacking spirit; the pulse of true heat must be slippery, forceful, and robust.

Eleventh, individuals with a Yang constitution tend to suffer from heat conditions, while those with a Yin constitution tend to suffer from cold conditions. Those with a Yang constitution invariably prefer cold drinks and fear heat; even if they consume cold food day and night without illness, this indicates an excess of Yang. Those with a Yin constitution will damage their Spleen and Kidney upon exposure to cold or cooling agents, indicating an insufficiency of Yang. However, those with strong Yang are few, comprising only two or three out of ten; those with weak Yang are many, comprising five or six out of ten. Yet, those who rely on their strength often fall ill, while those who fear weakness (and thus take care) remain healthy. If one envies another's strength while resenting one's own weakness, it is no different from a dwarf watching a performance or an ugly woman imitating Xi Shi holding her chest in pain.