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For all diseases, there are syndromes; examination must be precise and detailed. Each symptom has a cause; inquiry and pulse-taking should be accurate. The superior physician comprehends the movement of Heaven (natural laws) to treat future ailments; the average practitioner conforms to timely appropriateness to verify current conditions. On the left, it governs Blood and Yin; on the right, it governs Yang and Qi. When Yang overflows outward, it is inevitably violent and changes rapidly; when Yin is excessive internally, disaster is less likely to be delayed but spreads easily. Transmission from right to left involves contention between Qi and Blood; if Yang is excessive, there is restlessness in the morning and calmness in the evening. Transmission from left to right involves mutual pressure of Wind and Fire; if Yin is deficient, symptoms worsen at night and ease during the day.

Obese individuals have a lax middle jiao, loose muscle texture, and insufficient Qi consolidation; insufficiency generates Cold, Cold generates Dampness, and Dampness generates Phlegm. Thus, obese people tend to have much Phlegm, making them susceptible to external pathogens. Emaciated individuals have dry middles, fine and tight muscle textures, and often withered Blood; withering generates Heat, Heat generates Wind, and Wind generates Fire. Thus, emaciated people tend to have much Fire, making internal injuries common. Those with Wind-Cold invasion fear wind; Wind damages Wei (Defensive) Qi, causing fever, headache, spontaneous sweating, and tearing. Secondary invasion by Summerheat adds heat aversion. Those with Cold damage fear cold; Cold damages Ying (Nutritive) Qi, potentially causing sudden redness, swelling, pain, anhidrosis, and runny nose. False aversion to grain may involve food retention.

All itching belongs to Wind; after itching subsides, unbearable pain indicates prolonged Wind transforming into Heat. All pain belongs to Fire; extreme pain with excessive tearing and headache indicates excessive Heat generating Wind. Swelling and fullness indicate Dampness; however, if Dampness overflows upward severely, alternating itching and pain signifies excessive Heat. Tendon retraction indicates Cold; if accompanied by fright, tremors, heat, and sweating, blame should be placed on Wind pathogen. Know that mild pathogens cause itching, while heavy pathogens cause pain. Itching occurs both at the onset and resolution of disease. After severe illness, dizziness indicates unrepaid Jing (Essence) and Qi; initial acupuncture feels like obstruction, and Shen Water remains turbid. Hidden astringent pain is due to Yin deficiency and Fire agitation; tension and urgency are often caused by Spleen Earth dryness generating Wind.

Qi stagnation spreading causes severe head pain, red sclera like fire, and crisscrossing red vessels; this is a dangerous syndrome requiring rapid acupuncture to guide. Blood stasis causing distension leads to blindness, hot tears like soup, and viscous, hard black cornea; even in deficiency-cold constitutions, moxibustion/fire therapy is strictly contraindicated. Protruding eyes with many purple vessels indicate acute intermittent conditions; sunken eyelids with spots indicate deficiency of the Zang organs combined with Dampness. Congenital blood coagulation impedes Qi flow; childbirth depletes Ying and Wei. Impeded flow breeds Heat; insufficiency increases Cold. Therefore, Yang deficiency causes exterior Cold, Yang excess causes exterior Heat; Yin deficiency causes interior Heat, Yin excess causes interior Cold. External contraction of Wind-Cold can trigger internal Fire-Dryness, which eventually returns to deficiency-cold. This is the general principle.

Once pathological states form, "Li Palace" (upper eyelid area) shows iridescence; excessive Fire penetrates the Wind Wheel (cornea). Dry secretion condensation, Qi flaccidity flipping like spring water. "Colorful clouds holding the sun" indicates Blood disturbed by excessive pathogens, not necessarily Liver Wood demonization. "White nebula mixing with the pearl" indicates Yang suppressed by Yin, not necessarily Lung Metal failing in virtue. Qi fullness is like Fire stealing the Sun; high Wind is like Spring Water raising waves. Chaotic red filaments and wood halos bring Fire disasters; Yin-Yang rifts cause Qi deviation, flowing pain like needles. Cold-Damp staying in the middle causes Tian Shui (pupil/cornea) to turn yellow; otherwise, Earth (Spleen) burned by Fire causes Yang Jaundice; Fire drowned by Water causes Yin Jaundice. Uncontrolled Wind-Heat causes eyelid redness and erosion; otherwise, Phlegm-Fluid rising transforms into Heat-Damp erosion. Internal depletion of fluids and lack of Spring Qi causes dry erosion. Seeing meteors frequently suggests Kidney Qi injury; occasional fresh blood indicates Pathogenic Fire stagnating in the Liver channel.

Wine-drinkers suffer from damp-heat steaming, producing red-yellow fleshy growths; those with emotional excess suffer from Jing-Blood depletion, leading to visual hallucinations. Blood extravasation forms sores due to blazing Heart Fire affecting its offspring; millet sores are yellow and soft due to Damp-Heat; pepper sores are red and hard due to Wind-Heat. Heat excess forms fistulas where strong Liver Wind wanders to the Spleen; Yin fistulas are defined by southern fullness and northern exhaustion; Yang fistulas mimic central heat and external excess. Tears flowing with wind-cold or heat indicate Liver deficiency attracting pathogens; constant tearing day and night indicates Kidney decline causing dryness. Fire swelling of the head distinguishes between Wind-Heat and Damp-Heat; Wind causes distending pain, Damp-Heat arises from deficiency, beware of eye protrusion and bodily disaster. Heat aversion and photophobia distinguish Blood deficiency and Fire dryness; while Fire fears heat and Blood deficiency fears light, note that Spleen excess also fears heat.

Pterygium stems from Stomach excess and Heart labor, wrongly attributed to odd meridians' guest heat. Eye ulcers vary in severity but are governed by the Five Zang organs. Trichiasis and hanging spheres indicate Lung deficiency and Spleen fatigue; mouth and eyelid twitching indicate Blood exhaustion and Wind generation. Migraine and frontal headaches result from Wind disturbing Yin and Yang; occipital and vertex pains indicate pathogens residing in the Du and Ren meridians. In children, disease onset lacks root in Ying and Wei. Fetal Wind causes redness and erosion; fetal toxin causes macules and sores. Qi and Blood deficiency generates Wind, leading to deviation; vigorous Wind-Fire retains fluids, causing nebulae. Chickenpox and smallpox are often ominous, as turbid Qi harms clear harmony; malnutrition without treatment loses the source of nourishment. A smear of vermilion on the white sclera indicates reckless Heart Blood flow; blue tint on the Qi wheel indicates Liver pathogen steaming. Heat stagnation and Wind whirling resemble angry crabs across the eye; Blood stasis and blazing Fire resemble grieving sea snails emerging from shells. Inability to open eyes indicates tendon relaxation; staring upward indicates meridian severance. Convulsions and rolling eyes indicate convulsive wind and heavenly hook; rolling eyeballs indicate Wind-Fire rotation. Black cornea shaking without movement indicates epilepsy; frequent blinking of the flesh wheel indicates impending Liver malnutrition.

Dilated water wheel indicates either Wind or Phlegm-Heat urging; constricted golden well indicates damage to Spirit and Essence/Qi. Brain-like pulling sensation, deviation, or drooping requires prevention of reversal; splitting headache seeks fish-eye signs, controlling long drooping. Yellow fluid rushing upward and white membrane covering the center indicate true distension rather than pus; chicken-comb and fish-egg formations are all caused by Fire and Earth obstruction. Lipoid keratitis and flower-shaped white depression are fleshy, tender, and grow easily; large and small thunder-head nebulae are named Wind-Fire combining with Phlegm. Dryness indicates Heart-Kidney irritability; added pain causes nebula erosion. Flickering vision results from Yin-Yang confusion, worsening at night with deficiency. Diplopia and delusions return to normal after Fire subsides; vertigo and tilting earth do not recover after long periods. Ice pot and autumn moon, empty pool reflecting moon, indicate Qi knot and Essence injury. Reverse and smooth nebula formation, Yin-Yang double nebula, and paste stagnation. Floating duckweed and gathering star obstructions come and go with Wind-Heat, appearing intermittently; flowing gold and crescent moon theories involve Cold-Damp in the Qi wheel interacting with the Wind wheel. Closed clamshell with increased headache indicates Wood-Earth standoff; overturned cup before eye damage indicates Wind-Fire combination. These are difficult-to-treat syndromes. Worse still: Blindness (Qing Mang) and sudden blindness rarely heal one in three; Black Wind and Green Wind have no cure among ten thousand cases. Internal cataracts are secretly damaged by Seven Emotions; Yin Wind involves sinking of deficient Yang. Slight breakage of the Wind Wheel makes medicine ineffective, let alone sinking deeper; scorched pupil means no prescription can save, nor can protrusion into the orbit be managed. Thus, red nebula like vermilion surrounded by purple veins; smooth obstruction like porcelain with pure red surroundings. Near-sightedness, far-sightedness, Qi nebula, Qi wheel collapse, spirit exhaustion, Shen Water dryness, skin tightness, and eyelid paralysis are untreatable. Alas! Long-term blindness cannot be opened by acupuncture or herbs; without destiny, only helplessness remains. One must be careful-eyed, knowing light and heavy: diverse disease origins require studying combination and transmission variations; ineffective medication requires urgent bitter and acrid therapies first. Like clean dry soil without moss, why would it crack? Warm and thick Spleen naturally moves Qi, how could Phlegm stop? Wood likes free flow; dense shade causes leaf fall and worm generation; Fire likes flourishing; suppression yields smoke without flame. Metal does not fear Fire, so Lung disease does not necessarily cause photophobia; Water acts as a mirror, sufficient Kidney can surely illuminate objects. By such analogy, one finds the source everywhere. Originally, bodily harm and eye damage occur gradually, starting from the minute. To avoid gradual harm, prevent the minute. Supplement, harmonize, attack, and disperse are clear in mind; hook, cut, needle, and cauterize are error-free under fingers. With clear fingers, combine bright face. Left pulse large and rapid indicates Heart Fire旺盛; right pulse similar indicates Fire attacking Metal. Floating, rapid, slightly wiry indicates young Wind Wood; wiry and slippery indicates Wood overcoming Earth. Deep and small only in spring/summer indicates Cold-Yin not rising and Kidney Water; extra wiry and rapid in autumn/winter indicates Yang Water carrying Wood pathogen up. Deep and slow is originally Yin-Cold, involving slackness allows warm dispersal; floating and rapid is Yang-Heat, like moist need clearing and warming. Slippery relates to Heat and much Phlegm; choppy fears Qi stagnation and Blood dryness. In short, excess disease with excess pulse indicates harmonious Stomach Qi; excess disease with deficiency pulse requires first regulating Spleen Earth. Deficiency has five: thin pulse, cold skin, little Qi, diarrhea, inability to eat, preferring gruel to stop diarrhea. Excess has five: strong pulse, hot skin, abdominal distension, constipation, dizziness and delirium, expecting bowel/bladder opening and sweating. Disease in Yin with apparent Yang deficiency: draw Yang from Yin; obtaining Yang returns Fire to origin and Yin harmonizes. Disease in Yang with apparent Yin deficiency: draw Yin from Yang; Yin excess generates Qi from Essence and Yang hides. Exterior disease: do not attack interior, lest pathogen sinks into deficiency; opening ghost gates removes Wind and scatters Cold. Interior disease: do not falsely treat exterior, excessive sweating causes Yang loss; cleansing the water house calms Spirit and nourishes Blood. Dry Phlegm treats Fire; ineffective, regulate Qi. Fluid retention regulates Qi; insufficient, tonify Fire. Son makes Mother excess, draining Son treats branch urgently; Son makes Mother deficiency, tonifying Mother attends to root slowly. Spirit insufficiency warmed by Qi; Essence insufficiency nourished by Flavor. Qi hyperactivity and Blood misdirection require draining Fire; Yang decline and Yin following require warming Middle. Do not allow pathogens, do not lose righteousness, medicine is appropriate, and disease rises. Briefly stating insights, compiled in this chapter. Specialists, please study it carefully. However, master physicians, with flexible clinical wisdom, divine understanding depends on the person.