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When pathogenic qi wanders through the four limbs, causing swelling of the entire body and face, it appears to be due to Spleen deficiency but is actually not. In treating edema (swelling) and abdominal distension, bitter-pungent cold-natured herbs should be used as the principal agents, with a strong emphasis on promoting urination and defecation. The Classics state: "For fullness in the middle jiao, treat from within." If so, how can this be attributed to Spleen Earth deficiency? This view directly contradicts the *Suwen*. The Classics state: "All dampness-induced swelling and fullness belong to Spleen Earth." It also says: "Taiyin governs swelling." Furthermore: "Excess dampness leads to loose stools; in severe cases, it causes urinary obstruction and swelling. These all refer to excess damp-heat of Taiyin Spleen Earth." Additionally, the Classics state: "All abdominal distensions and enlargements belong to Heat." And: "All swelling, pain, soreness, fright, and agitation belong to Fire." It also states: "Excess heat leads to swelling." These all indicate excess-heat of Heart Fire. How can one claim that Spleen deficiency fails to control Kidney Water, leading to excess? Therefore, various forms of edema are caused by the combination of dampness and heat. Just as in the sixth month when damp-heat is excessive and all things flourish, the phenomenon of edema is clearly visible. Thus, the ancients formulated treatments using bitter-pungent cold-natured herbs. Pungency disperses stagnation, bitterness dries dampness, and cold clears heat. With the unblocking of bowels and urine, dampness is removed, stagnation dissipates, heat recedes, and qi harmonizes, resulting in recovery.

Those who falsely attribute edema to Spleen deficiency failing to control Kidney Water merely argue that frequent purging causes this condition and that there is an accumulation of fluids. They fail to realize that the hot toxicity of Croton seed (Badou) depletes the yang qi of Kidney Water, causing Heart Fire and Spleen Earth to become hyperactive. When dampness and heat contend, they cause qi stagnation and blockage, leading to difficult urination and edema. In such cases, purging is appropriate because bitter-pungent cold herbs can resolve damp-heat stagnation and blockage. This is similar to early purging in Cold Damage (Shanghan), where heat penetrates inward to form chest binding (Jie Xiong); here, cold-natured formulas like Xiaoxin Tang or Wan should be used for purging. Similarly, if Cold Damage is mistakenly treated with hot-toxic purgatives like Croton seed, worsening the heat, then cold-natured formulas like Tiaowei Chengqi Tang should be used for purging. As for the silver powder (Yinfen) remedies circulated among the people, which cure edema, it is because they effectively open up stagnation and blockage. However, one must be cautious not to overuse them and cause harm! Moreover, silver powder can damage teeth. This is because its toxic fumes affect the stomach and intestines, and the spirit, blood qi, and grain essence cannot overcome the toxicity. Consequently, the toxic fumes travel along the meridians upward to the tender and thin gingiva, causing harm. The spaces between the upper and lower teeth are traversed by the Hand and Foot Yangming Stomach meridians. When using such drugs, one must first secure and protect the spleen and stomach! Some claim that generalized yin-edema accompanied by aversion to cold is purely a cold syndrome. This is incorrect. The Classics state: "The arrival of Shaoyin君火 (Ministerial Fire) manifests as fright, confusion, aversion to cold, shivering, weeping, laughing, and delirious speech." See the discussion on aversion to cold and shivering below.

(Mao)
Mao: Dizziness or clouding of consciousness. When heat qi is excessive, turbidity confuses the mind, leading to dizziness and mental cloudiness.

(Yu)
Yu: Frustration or depression (Fuyu). It refers to stagnation, obstruction, and blockage where qi flow is not smooth. This is described as heat becoming excessive, closing the pores (Couli), and causing qi stagnation. Like fire smelting objects, extreme heat causes fusion where separation is impossible; thus, heat stagnation leads to blockage and lack of smooth flow. Although cold water governs closure and storage, the current attribution to heat occurs because when fire-heat reaches extreme hyperactivity, it counteracts itself by adopting the transformation of water.

(Zhong Zhang)
Zhong Zhang: Swelling and distension. When heat dominates internally, qi stagnates, leading to swelling. Excessive yang-heat causes abdominal distension. Fire governs growth and flourishing, manifesting prominently in shape and appearance; rising brightness and舒展 prosperity are all images of swelling and distension.

(Bi Zhi)
Bi Zhi: Nasal congestion. Zhi means blockage. Fire governs swelling; thus, when heat pathogens lodge in the Yangming meridian, nasal swelling causes blockage. Some argue that since cold governs closure, nasal congestion must be cold. This is erroneous. It is because yang qi is excessive in the upper body; when lying on one side, the upper nostril remains patent while the lower becomes blocked. This is due to the crossing of Yangming meridians: the left meridian injects into the right nostril, and the right into the left. Therefore, wind-heat stagnation affecting the left side may cause blockage in the right nostril. Laypeople, unaware of this meridian crossing, see the upper nostril clear and the lower blocked when lying down, and wrongly suspect cold. The principle of patency and blockage corresponds to the expansion and contraction of Lung Metal.

(Qiu)
Qiu: Flowing clear mucus from the nose. According to the principles of the Five Elements, when subtle, elements exhibit their own transformations; when excessive, they exhibit the transformation of the element that conquers them ("Ghost/Thief" qi). Thus, the Classics say: "Hyperactivity causes harm; succession brings restraint." The I Ching states: "Nothing dries things more than fire." Using fire to refine metal, extreme heat transforms it into water; when the body is extremely hot, sweat is produced; water is soft and compliant, but extreme cold turns it to ice like earth. Earth governs damp-yin clouds and rain, remaining quiet; but when earth-dampness is excessive, it turns to sudden torrents, fierce winds, and overflowing rain. Wood governs mild warmth and flourishing; excessive wind turns cool and causes breakage. Metal governs coolness; extreme autumn coolness makes things dry. All these illustrate that when extremes are reached, the conquering element's transformation appears to restrain the excess. Therefore, excessive liver-heat produces tears; excessive heart-heat produces sweat; excessive spleen-heat produces saliva; excessive lung-heat produces nasal discharge; excessive kidney-heat produces spittle. The Classics state: "Heat in the nose produces turbid mucus." Any phlegm, saliva, mucus, or spittle that is thick and turbid is caused by extreme fire-heat scorching fluids. Some claim Qiu is due to lung-cold; this is wrong. They observe clear runny nose, sneezing, nasal congestion, and worsening in cold, and conclude it is cold. They do not realize that cold damaging the skin and hair closes the pores, trapping extreme heat and frustration, worsening the disease.

(Nv)
Nv: Epistaxis (nosebleed). Yang-heat frustration invades the Foot-Yangming meridian and ascends. Extreme heat causes blood to move recklessly, resulting in epistaxis.

(Xue Yi)
Xue Yi: Hemorrhage flowing upward. The Heart nourishes blood; thus, extreme heat causes blood excess and reckless movement. Some claim vomiting purple clotted blood indicates cold; this is wrong. It is not due to cold coagulation, but rather extreme heat scorching the blood to make it thick and turbid. Since heat is excessive, the water-element restrains it, mixing red and black to form purple.

(Xue Xie)
Xue Xie: Bleeding from the bowels or bladder. Heat pathogens lodge in the Lower Jiao, causing blood in stool or urine.

(Lin)
Lin: Dysuria characterized by painful, difficult urination. Heat pathogens lodge in the Bladder, causing stagnation and inability to excrete. Some say dysuria with difficulty is heat, while enuresis (involuntary urination) is cold. This is mistaken. Extreme heat lodging in the Kidney region and invading the Foot-Jueyin Liver meridian causes extreme stagnation at the anterior orifice (Ting Kong). Qi and blood cannot circulate freely, leading to flaccidity and numbness, rendering the spirit ineffective. Consequently, fluids seep into the Bladder, and urine is lost involuntarily. The Classics state: "The eyes see with blood, ears hear with blood, hands grasp with blood, palms hold with blood, feet walk with blood, zang organs secrete with blood, and fu organs move qi with blood." Blood follows qi; when qi and blood circulate smoothly, the spirit is clear and responsive. It is said: "Qi and blood are the spirit of humans; they must be carefully nourished." Therefore, functions improve with practice as qi and blood flow; obstruction weakens them. If extreme heat causes stagnation, qi and blood cannot circulate, the spirit loses function, and abilities decline based on the severity of stagnation. Thus, eye stagnation impairs vision; ear stagnation impairs hearing; nose stagnation impairs smell; tongue stagnation impairs taste. Flaccidity and bone bi syndromes, and loss of other functions, are all due to heat-stagnation. Zhang Zhongjing discusses extreme heat in Shaoyin disease: "Incontinence, delirium, and fixed staring eyes indicate the Kidney is failing first." The *Lingshu* states: "The Kidney governs the two yin orifices." When water deficiency allows frustrated heat to lodge, the two yin orifices stagnate, causing flaccidity and loss of control, proving the heat syndrome. Thus, although folk theories call it "cold lin," they use cold herbs like Ulmus bark, Scutellaria, Buckwheat, Poria, Akebia stem, Elsholtzia, Prunus seeds, and Gardenia. Though the theory is wrong, the formula works because they misunderstand the dynamics of qi transformation. Some claim treating lin with warm herbs like Fennel, Alpinia, Talcum, and wine cures it, implying it was cold. However, these are key diuretics. Although wine and Alpinia are warm, Fennel is warm and Talcum is cold; together they open stagnation, promote qi-fluid circulation, disperse heat, and cure the disease.

(Bi Mi)
Bi Mi: Commonly written as Bi, referring to constipation with difficult passage. Heat consumes fluids, causing hard feces and dry, tight constriction of the Large Intestine. Alternatively, loose stools with difficulty passing occur when dry-heat is outside the intestines and damp-heat is inside. This shares meaning with tenesmus discussed under "Lower Urgency."

(Shen Re Wu Han)
Body heat with aversion to cold indicates heat in the exterior. Pathogenic heat is superficial; the pathogen fears the righteous qi, so fever presents with aversion to cold. Claims that aversion to cold always mean exterior cold, or that body heat with aversion to cold means heat in the skin and cold in the marrow, are errors. Zhang Zhongjing’s method states: "In diseases without yang, cold prevails; do not induce sweating." He also says: "For body heat and aversion to cold, use Mahuang Tang to induce sweating. Once sweat is released and heat gone, the body cools and heals." Thus, how can it be cold? Similarly, heat-induced abscesses with aversion to cold are due to pathogenic heat in the exterior. However, sweating is contraindicated. Zhang Zhongjing states: "Sweating in carbuncle patients induces pus formation." Generally, irritability, thirst, preference for cold, and aversion to heat indicate heat disease. There is also the principle of "hyperactivity causes harm; succession brings restraint," where extreme heat may feel cold. Although feeling cold, the disease is heat, not cold. When heat stagnation is severe, aversion to cold occurs; cold worsens it, while warmth alleviates it slightly. Warmth opens pores, disperses yang qi, reduces frustration-heat, and provides slight relief. Cold closes pores, traps yang qi, increases heat, and worsens the disease. This applies throughout the body. Laypeople mistakenly diagnose cold and use hot herbs, causing great harm. If hot herbs temporarily relieve frustration-heat, the disease worsens once the drug effect wears off. Minor improvement is followed by major worsening. Unaware, people continue taking them, generating various heat diseases.
Yang-heat flare-ups cause severe stagnation above, leading to dizziness, deafness, tinnitus, and upper congestion epilepsy. Upper heat excess with lower heat deficiency is often falsely attributed by laypeople to Kidney Water deficiency failing to control Heart Fire, labeled as deficient heat. Not knowing that nourishing water and draining fire requires cold herbs, using hot herbs to nourish Kidney Water and suppress Heart Fire causes significant disaster. One must be cautious!

(Zhan Li)
Zhan Li: Trembling and shivering, an image of Fire. Yang moves, Yin rests; Water and Fire oppose each other. Thus, reversal, rigidity, and difficulty moving indicate cold disease. Shivering implies cold. Claiming chills are Spleen-cold shows ignorance of transformation. This results from extreme Heart Fire trembling due to hyperactivity, counteracting itself with Water transformation, hence cold shivering. Cold shivering arises from fire resembling water, not actual cold. Purging with Dachengqi Tang often expels dry feces; after purging, heat recedes, and shivering resolves. Alternatively, ordinary people shivering from extreme cold experience cold governing closure, preventing yang dispersion, causing internal frustration-heat, like ground warmth in winter.
Some argue: In winter, yang is inside, yin outside; ground is cold, underground warm. Summer is opposite. This is true. At Winter Solstice, earth-yin is extreme, generating rising yang; by Summer, yang is above, yin below, making surface hot and underground cold. But at Summer Solstice, heaven-yang is extreme, generating descending yin; by Winter, yin enters the ground, making it warm again, while surface is cold. Or claiming yang rises out after winter and descends in after summer is speculation. At Winter Solstice (Zi hour), one yang rises, reaching Fu hexagram; by Si month, yin ends, six yangs complete, reaching Pure Qian. At Summer Solstice (Wu hour), one yin is born, reaching Gou hexagram; by Hai month, yang ends, six yins complete, reaching Pure Kun. By Winter Solstice, yang returns. Facing south after Zi, north after Wu, observing hexagram lines, it is clear yang rises after Zi and yin descends after Wu. How can one say yin descends after winter and yang descends after summer?
Seasonal weather follows the rise and fall of Yong Qi (Vital Qi). In a year, the five movements (Wind, Summer-heat, Dryness, Dampness, Cold) each govern 73 days and 5 ke, totaling one year. The six main positions: Da Han to Chun Fen belongs to Wood, hence mild and windy; Chun Fen to Xiao Man belongs to Jun Fire, hence warm; Xiao Man to Da Shu belongs to Xiang Fire, hence hot; Da Shu to Qiu Fen belongs to Earth, hence damp and cloudy; Qiu Fen to Xiao Xue belongs to Metal, hence cool and dry; Xiao Xue to Da Han belongs to Water, hence cold. Thus, is it caused by yin-yang rising/falling inside/outside the earth?
Regarding underground temperature: The Classics state fire-heat governs movement, cold-water governs closure. When weather is hot, earth qi vents outward, making underground cold (like cooling after sweating). When weather is cold, earth freezes and closes, qi cannot vent, causing frustration and underground warmth. The Classics say: "Humans injured by cold develop heat diseases." Water is naturally cold; extreme cold makes it ice, yet water beneath ice is not cold; thicker ice means warmer water, illustrating closure. Heavy snow and ice, extreme closure, make water very warm, killing fish. Thus, at Zi hour one yang is born, reaching Yin month three yangs are born, attaining Tai hexagram (Earth Heaven Tai), meaning smooth flow, not blockage. At Wu hour one yin is born, reaching Shen month three yins are born, attaining Pi hexagram (Heaven Earth Pi), meaning blockage, not smoothness. Yet Pi extreme becomes Tai, Tai extreme becomes Pi. So in sixth month Tai extreme, underground is coldest; in twelfth month Pi extreme, underground is warmest. Underground temperature changes are evident. Thus, humans exposed to cold may develop internal heat.
Question: Why is the interior warm in winter and cold in summer? Answer: Laypeople have been wrong for long. Body qi follows seasonal Yong Qi rise/fall without opposition. Pulse diagnosis clarifies this. In summer, Heart Fire generates heat; pulse is slippery, rapid, large, and long; symptoms include irritability, heat, and thirst. Is this cold? Other pulses are similar.
Ordinary people trembling from extreme fear: Fear is the will of the Kidney. Excessive fear damages the organ, weakening Kidney Water, allowing Heart Fire to dominate, causing tremors. Alcohol is bitter and hot, nourishing Heart Fire; excessive drinking causes extreme Heart Fire and tremors, known as "wine prohibition."
The Classics state: "Yang merges with Yin, Yin becomes excess, Yangming becomes deficient. Yang deficiency causes cold shivering and jaw quivering." Commentary: "Yang merging with Yin means yang qi entering yin divisions. Yangming is the Stomach meridian; insufficiency causes aversion to cold, shivering, and jaw quivering." Although Yangming meridians are superficial and govern muscles, qi merging inward makes it "Yangming deficiency."
The Classics state regarding Malaria: "At onset, yang merges with yin; yang is deficient, yin excess, no yang externally, hence initial chills. When yin qi reverses extremely, yang re-emerges, merging with yin externally; yin becomes deficient, yang excess, hence initial heat and thirst." "Yang emerging" means yang is exterior, yin is interior. Qi re-emerging to the exterior does not mean cold qi becomes hot.
The Classics state: "Malarial qi merging with yang makes yang dominant; merging with yin makes yin dominant. Yin dominance is cold; yang dominance is heat." Merging with yang (exterior) is yang dominance; merging with yin (interior) is yin dominance. This refers to interior-exterior yin-yang deficiency/excess, not cold-heat victory/defeat, but simply yang qi entry/exit.
In deepening Cold Damage, exterior signs cease, heat enters interior. To produce heavy sweating, yang must exit outward. Extreme stagnation releases, causing massive interior yang-heat. Hyperactivity causes harm; succession brings restraint, hence shivering. Then yang exits to exterior, steaming heat opens pores, heavy sweat releases, and pathogenic qi ends. Shivering without sweat recovery occurs due to excessive fluid loss from sweating/vomiting/purging, preventing sweat production; heat recedes, qi harmonizes, and recovery occurs. Recovery without shivering and with sweating happens when exterior heat persists, interior-exterior both hot, yang does not merge with yin, exterior qi is robust, interior lacks extreme hyperactivity, so no "succession/restraint" mechanism triggers shivering. Recovery without shivering and without sweating occurs due to yang not merging with yin and qi/fluid deficiency. Thus, all shivering results from exterior yang merging with pathogenic heat in the interior; extreme heat triggers water transformation, causing cold shivering. Although it seems cold, it is extreme interior heat, fire extreme resembling water transformation.

(Jing)
Jing: Sudden heart palpitation and restlessness. Fire governs movement, so extreme Heart Fire causes this. Although it is extreme interior heat, fire extreme resembling water causes fright. It counteracts with Kidney Water fear due to "hyperactivity causes harm; succession brings restraint." Fear damages Kidney, depleting water, allowing Heart Fire to dominate, hence fright.

(Huo)
Huo: Doubt, hesitation, turbidity, and scattered will. Like fire flickering, causing confusion. When fire is excess, water is deficient, will is lost, and confusion ensues. Will is the spirit of Kidney Water.

(Bei)
Bei: Grief, the will of Metal/Lung. Metal is naturally dry; fire causes dryness. Heart Fire governs heat and pain; grief and suffering reflect vexed, hot, restless heart spirit, not clarity. Crying and five fluids exiting result from extreme fire-heat counteracting with water transformation. The five zang organs are Liver, Heart, Spleen, Lung, Kidney. Their wills are Anger, Joy, Grief, Thought, Fear. Grief is also called Worry. Excessive will causes labor, damaging the organ. All five will injuries involve heat.
The six desires are Eye, Ear, Nose, Tongue, Body, Mind. The seven emotions are Joy...