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The two patterns of Yin and Yang intersect, with life and death intertwined, a matter that can be clearly discerned: slight fever, slight aversion to cold, slight redness and swelling; half-comatose yet half-alert, the lesion is half-flat yet half-elevated; the pulse comes rapid but mostly forceless; although food is consumed, bowel movements are irregular; swelling without ulceration is due to Spleen deficiency, while ulceration without healing is due to excessive pus; stools are often loose, urination frequent; sweat on the upper body with dryness and scorching sensation in the lower limbs; although some of the Five Good prognostic signs are present, none of the Seven Evil prognostic signs have been entirely escaped; thirst with a desire for tea, abdominal pain and intestinal rumbling, facial edema with aversion to drinking, elevation of the soles of the feet; mental restlessness and inability to sleep, mental confusion with fear of noise and agitation. Prescribing formulas that respond effectively is considered skillful; if Yin transforms into Yang, gradual regulation becomes possible. Encountering such conditions, even with the hands of an immortal, one cannot guarantee escape from a state of half-death and half-life. (From *Zhengzong*)

Gu Shicheng states: Among the manifestations of carbuncles and ulcers, pure Yang patterns are indeed common, while pure Yin patterns are originally rare. The pattern of half-Yang and half-Yin is the most prevalent. It entirely depends on the physician's attentiveness; it must not be neglected. For patterns where Yin and Yang are mixed, if warm-acrid agents are used internally and externally, the Yin Qi will gradually dissipate, transforming into a Yang pattern. If cooling agents are applied externally, or medicines are mixed with cold honey and egg white for topical application, and bitter-cold detoxifying agents are administered internally, the Yang Qi will be frozen and stagnant, transforming into a pure Yin pattern. Fortune and misfortune can reverse in an instant; both physicians and patients should remain vigilant.

The Classics state: All pain, itching, sores, and ulcers belong to Heart Fire. However, there are cases where the initial presentation features purple-red coloration with swelling and pain, a deep, fine, and rapid pulse, aversion to cold, and preference for warmth. This is not true Cold; rather, it is extreme Heat resembling Water, extreme Yang generating Yin, following the principle that hyperactivity causes harm, and control brings balance. This may result from a lifestyle of luxury, consumption of rich and greasy foods, or ingestion of mineral drugs. Thus, extreme Yang resembles Yin, leading to variations starting with heat and ending with cold. It is appropriate to follow the timing and treat internally with formulas such as those that vent and support, or clear Heart Fire, which will lead to recovery.

Gu Shicheng states: False Cold is essentially extreme Heat resembling Water. In the initial stage of sores and ulcers, if intense Heat is not resolved through sweating, the Yang pathogen becomes hyperactive to the extreme and stagnates within. Consequently, the pathogen transmits from the Yang meridians to the Yin aspects, resulting in body heat, cold extremities, lethargy, or aversion to cold, mimicking a Yin pattern. True Cold inherently involves aversion to cold; False Cold also involves aversion to cold. This is because "the deeper the heat, the deeper the cold extremities"; extreme Heat manifests with apparent Cold transformation. Generally, this pattern presents with a strong voice and coarse breathing, a robust physique, scorched lips and black tongue, thirst with a desire for cold drinks, dark and scanty urine, and constipation. Or, due to excessive intake of medicinal decoctions, it may cause diarrhea of clear water only, yet still retain dry feces and extremely foul-smelling flatulence. Examination of the six pulses will reveal them all to be deep, slippery, and forceful, indicating a Yang pattern. In miscellaneous diseases, false Cold may also manifest as aversion to cold or shivering. This occurs because extreme Heat is internal while Cold invades externally; the Cold and Heat energies do not harmonize, leading to chills. This indicates Cold in the skin and Hair follicles, and Heat in the bone marrow. The so-called aversion to cold is not true Cold, but a Heat pattern. By observing the internal signs—such as preference for cold, constipation, hot and difficult urination, bad breath, and irritability—and noting that the pulse is slippery, full, and forceful, one should immediately use formulas like Liang Ge San (Cool the Diaphragm Decoction) or herbs like Huangqin (Scutellariae Radix) and Lianhua (Coptidis Rhizoma) to nourish Yin and clear Fire. Once internal Heat is eliminated, external Cold will naturally subside. This aligns with the principle that "water flows to dampness." Therefore, whenever the body feels cold with cold extremities, yet the pulse is slippery and rapid, beating forcefully against the fingers upon palpation, this is extreme Yang resembling Yin, and is not a Cold pattern.