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The patterns of Yin and Yang must be examined in detail. A survey of the myriad diseases described in the *Neijing* (Inner Canon) reveals that their origins all stem from excessive emotions, irregular diet, inappropriate exposure to cold or heat, and injury from overwork. Yuan Qi (Original Qi), Gu Qi (Grain Qi), Ying Qi (Nutritive Qi), Qing Qi (Clear Qi), Wei Qi (Defensive Qi), and the ascending Qi of generating Yang—these six are merely different names for the same substance: the Qi rising from the stomach after food intake, derived from Grain Qi. Once the Spleen and Stomach are injured, the Central Qi becomes deficient; when Central Qi is deficient, the Yang Qi of the Six Fu Organs withers at the exterior. Thus, the Classic states that "the Qi of the Five Zang Organs has withered at the exterior," referring to a disease of the Yuan Qi of the Six Fu Organs. When Qi is injured, the Zang Organs become diseased; when Zang Organs are diseased, the physical form manifests corresponding symptoms. This indicates that the True Qi of the Five Zang and Six Fu Organs is insufficient. Only when Yin Qi becomes excessively prosperous and attacks the Yang aspect does it cause a loss of control over Ying and Wei Qi, giving rise to various diseases. These changes all occur because the deficiency of Central Qi hinders the mechanism of generation.

Later, if the Spleen and Stomach have already suffered from injuries due to overwork, and diet remains irregular, with the illness lingering for a long time, once external affairs cease and the mind is at peace, excessive fullness after eating can trigger a severe exacerbation of the disease. Generally, external invasions by Wind-Cold and the Six Excess Pathogens belong to excess patterns, which should be drained rather than tonified. In contrast, diseases caused by irregular diet leading to Central Qi deficiency belong to deficiency patterns, which should be tonified rather than drained. Physicians of the world mistakenly identify these deficiency patterns of Central Qi (caused by irregular diet and overwork, requiring tonification) as excess patterns of external Wind-Cold invasion (requiring draining). By heavily draining the exterior, they cause the Ying and Wei Qi to completely wither at the surface, leading to death within ten days. As the saying goes, "A miss is as good as a mile"; how can one fail to distinguish them carefully?

According to the *Yin Yang Ying Xiang Da Lun* (Great Treatise on the Correspondence of Yin and Yang): "Heavenly pathogenic qi, upon affecting the body, harms the Five Zang Organs." This refers to the Eight Excess Pathogens, specifically Wind invading the sinews and bones. Wind enters from above; Wind injures sinews, Cold injures bones. This occurs because tangible structures are affected, and the pathology lies in the Lower Jiao, involving the Liver and Kidneys. The Liver and Kidneys correspond to Earth Qi. The *Nan Jing* (Classic of Difficult Issues) explains: "The Qi of the Liver and Kidneys has withered internally." Since the Liver governs sinews and the Kidneys govern bones, Wind pathogens invading the body cause pain in sinews and bones; the withering of sinews and bones implies the withering of the root of the Liver and Kidneys. This is an excess pattern.

It also states: "Cold and heat from water and grain, upon affecting the body, harm the Six Fu Organs." This is the Seven Losses disease, resulting from internal dietary injury. The *Huangdi Zhenjing Jie* (Explanation of the Yellow Emperor's Needle Classic) says: "Inappropriate diet and overwork lead to Dampness entering from below." This refers to the insufficiency of Spleen-Stomach Qi causing it to descend abnormally; at its extreme, Fire from the Chong Mai (Penetrating Vessel) rebels upward. This affects intangible Yuan Qi, with pathology located in the Upper Jiao, involving the Heart and Lungs. The Heart and Lungs correspond to Heaven Qi. Thus, the *Nan Jing* explains: "The Qi of the Heart and Lungs has withered externally." The Heart governs Ying (Nutritive) Qi, and the Lungs govern Wei (Defensive) Qi. Ying is Blood; vessels are the residence of Blood and the dwelling place of Shen (Spirit). Wei is Yuan Qi, a branch of Shen, protecting the whole body and residing between the skin and hair. If Lung Qi fails, the skin and hair wither first, leaving Shen without support. Therefore, internal dietary injury also causes aversion to wind and cold because Ying and Wei control is lost, and there is no Yang Qi in the skin to nourish it, making it unable to withstand Wind-Cold. The withering of the skin and hair implies the withering of the root of the Heart and Lungs. Essentially, because Stomach Qi does not ascend and Yuan Qi is not generated, the Heart and Lungs cannot be nourished; this is a deficiency pattern.

Among those who fall ill, many suffer from internal injury due to overeating following irregular diet and overwork, while fewer suffer from external injury. Laypeople do not understand this and often mistake deficiency patterns of Yuan Qi for excess exterior patterns of Wind-Cold invasion, wrongly draining the Heart and Lungs, thereby doubly exhausting the exterior. How could such patients not die? As the ancients said, "Treating excess as excess and deficiency as deficiency" leads physicians to kill their patients. If you doubt this, consider the observations of the public. During the Renchen year, when the capital was under siege for half a month out of three months, after the siege was lifted, almost everyone fell ill, and deaths followed continuously. At the twelve gates of the capital, thousands of corpses were brought daily for nearly three months. Surely, not all of this million people contracted Wind-Cold externally. It is obvious that people in the besieged city suffered from irregular diet and overwork. After months of morning hunger and evening fullness, irregular rest, and temperature imbalance, Stomach Qi had been depleted. Once they ate too much upon relief, combined with improper treatment, death was inevitable. This was not limited to Daliang; places like Zhending, Dingzhou, Dongping, Taiyuan, and Fengxiang saw similar post-siege deaths from illness and injury. In Daliang, I witnessed cases where physicians used diaphoretic methods, purgatives like Radix Euphorbiae Pekinensis (Badou), or Decoction of Da Huang (Chengqi Tang). Subsequently, conditions transformed into Jie Xiong (Chest Binding) or Jaundice, treated with Xia Xiong Tang Wan and Yin Chen Tang, resulting in certain death. Initially, these were not Shaoyang or Taiyang syndromes; the transformations mimicking true Shaoyang/Taiyang syndromes were the fault of medication. Past mistakes cannot be undone, but future ones can be avoided. I have written this treatise based on my clinical experience to clarify the theories of past sages and document recent events, hoping colleagues will examine it carefully, apply it flexibly, and prevent unnecessary premature deaths.

**Differentiation of Yin and Yang Patterns**

Both external Cold invasion and internal injuries from irregular diet/overwork present with fever and chills. The world generally mistakes internal deficiency patterns for external excess exterior patterns, draining the exterior and causing wrongful deaths. This stems from failing to differentiate cold and heat. Now, let us analyze them in detail:

External Cold invasion presents with simultaneous fever and chills. The fever is described as "Xi Xi" (gentle/warm) or "Fu Fu" (fluttering), occurring on the skin and hair, indicating the heat is at the exterior. This is Cold invading the high Yang regions (skin, pores, hair follicles), which are nourished by Wei Qi. Cold constrains the Yang, preventing its extension, thus causing fever. The face may be red, nasal congestion present, and mental restlessness; slight exposure of the skin makes one sensitive to cold. This superficial heat is mild. However, aversion to cold is severe; even wearing heavy clothes, using curtains, or sitting near fire brings no comfort. The aversion worsens over time until the pathogen enters the interior and forms a lower Jiao excess pattern. The fever and chills occur simultaneously without interruption.

Internal injury from irregular diet or overwork may present with headache, stiff neck, and back pain, slightly resembling Taiyang exterior syndrome, but otherwise distinct. Internal deficiency means there is no Yang at the exterior to resist Wind-Cold, so aversion is constant. Restless heat arising from the Kidney area occurs intermittently and differs significantly from external Cold. The aversion to Wind-Cold here results from Spleen-Stomach deficiency causing Ying Qi to flow downward and attack the Liver-Kidneys, a precursor to flaccidity and reversal. Normally, Spleen Qi sends Ying Qi upward to the Heart-Lungs to nourish the upper Jiao skin and pores. When Ying Qi flows downward, the Heart-Lungs lack nourishment, and the skin loses Yang protection. Consequently, the Yang aspect of the skin and hair becomes weak; any encounter with Wind, Cold, shade, or sun triggers aversion. This is constant and uninterrupted. Avoiding Wind-Cold, staying warm, or adding clothing relieves the aversion. This heat is not external Cold-heat in the skin but rather Dampness from downward-flowing Spleen Qi blocking the lower Jiao, causing Yin Fire to flare up. This steaming restless heat spreads to the head, neck, and skin. Relief comes only by exposing oneself to cool air or sweating profusely. External Cold-heat rarely involves sweating; if sweating occurs, the disease resolves. Thus, differentiation is as clear as black and white.

Internal deficiency causes restless heat. Inhaling Cold-Wind may constrain Yin Fire, blocking the throat and diaphragm, preventing Qi entry. Chest Qi is constrained by external Wind-Cold, causing open mouth, staring eyes, vocalization, and suffocation sensation. Hiccups, choking, or vomiting may accompany this restless heat. The exterior deficiency aversion reappears. The weakness of the exterior allows Yin Fire to attack, causing brief restlessness. The lack of Yang in the exterior makes one susceptible to Wind-Cold again. Thus, exterior Yang deficiency is constant, while restless heat is intermittent. Unlike external patterns where fever and chills occur simultaneously without pause, here they alternate.

All diseases may present with body heat, muscle heat, or skin heat, palpable to the touch, representing tangible heat in the body structure. Recovery requires the harmony of Yin and Yang through sweating. Differentiation here is difficult because both deficiency/excess and internal/external patterns can present similarly. One must rely on the patient's subjective feeling of fever/chills and restless heat as the standard.

**Differentiation of Cold and Heat**

External invasion of the Eight Winds is an excess pattern. Internal injury from diet/overwork is a deficiency pattern. Internal injury may involve aversion to Wind and spontaneous sweating, but this disappears in warm, windless environments. This resembles external Wind invasion (clear nasal discharge, headache, sweating) but differs significantly upon analysis. External Wind invasion features constant aversion to Wind, sweating, headache, and clear nasal discharge, worsening progressively until entering the interior. Voice is heavy and resonant, nasal breathing obstructed, appetite normal, digestion normal, bowels/bladder normal, but sinews/bones hurt, preventing movement without support.

Internal injury from diet/overwork also involves aversion to Wind, but large winds outdoors do not aggravate it; only small drafts from windows/doors cause severe aversion, differing from Wind-Cold invasion. Clear nasal discharge, headache, and sweating occur intermittently. Shortness of breath, weak voice, poor appetite, abdominal discomfort, inability to extend the abdomen, loss of taste, frequent urination without thirst, constipation or loose stools, or blood/pus in stool may occur. Epigastric fullness or chest obstruction like knife pain may appear. Sometimes pain radiates from the epigastrium to the hypochondrium, driven by Min Fire (Ministerial Fire) surging upward like a river, disrupting the Yangming Meridian in the chest. Severe cases involve panting, Qi damage, limb flaccidity, lethargy, and desire to sleep. None of these occur in external Wind-Cold, making differentiation easy.

**Differentiation of Hand Temperature**

In internal injury/overwork/dietary irregularity, the palm is hot while the back of the hand is not. In external Wind-Cold, the back of the hand is hot while the palm is not. This distinction is very clear.

**Differentiation of Mouth and Nose**

If injured by diet/overwork, external signs manifest in the mouth: loss of taste, inability to digest grains, abdominal discomfort, reluctance to speak (weak voice if forced), excessive saliva, and possibly clear nasal discharge. This is a Yin pattern. If injured by external Wind-Cold, signs manifest in the nose: nasal obstruction, turbid voice, strong speech, and normal mouth taste. Cold invasion causes red face and dry nasal congestion; Wind invasion causes clear nasal discharge. The *Neijing* states: "The nose is the aperture of the Lung, connecting to Heaven." External Wind-Cold obstructs the nose. The mouth corresponds to Earth (Spleen); Spleen Qi connects to the mouth. Dietary irregularity/overwork causes loss of taste for grains and flavors. "Food stagnation causes aversion to food" is evident.

**Differentiation of Breath Strength**

External Wind-Cold presents with robust, excess Qi. Internal injury presents with short, insufficient breath from mouth and nose. Why? External Wind-Cold does not initially deplete Heart-Lung Yuan Qi but adds pathogenic Qi, causing nasal obstruction, red face, and forced exhalation through the mouth. Speech starts light and ends heavy, loud and forceful—signs of excess. Wind invasion causes clear nasal discharge, hoarse voice, resonant speech (like from a jar), starting light and ending heavy, loud and forceful—also signs of excess Qi. Internal injury/depletion damages Heart-Lung Qi first, causing heat and Qi deficiency. Limbs lack strength. Mouth and nose show shortness of breath, panting, reluctance to speak. If questioned, the patient answers reluctantly, with weak and low Qi—signs of deficiency. This is clear enough for anyone to distinguish.

**Differentiation of Headache**

Internal headache comes and goes. External headache is constant until the pathogen enters the interior and becomes excess. This distinguishes internal from external patterns.

**Differentiation of Limb Condition**

Internal injury implies Heart-Lung Qi has withered externally, causing lethargy, drowsiness, and heavy, flaccid limbs. This is Heat damaging Yuan Qi; the Spleen governs limbs, and Heat deprives it of Qi. The Classic says: "Heat damages Qi" and "Heat causes bone wasting and sinew laxity." External Wind-Cold implies Liver-Kidney Qi has withered internally. Kidneys govern bones (Cold); Livers govern sinews (Wind). Ancient texts treat Liver-Kidney diseases together as they support each other. The Classic states Gallbladder governs bones and Bladder governs sinews. Stroke or Cold invasion causes immediate bedridden state, inability to move, and sinew/bone pain—tangible structural injury. The Classic says: "Cold damages form" and "Cold causes sinew spasm and bone pain."