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Various instances of vomiting and acid regurgitation, as well as sudden diarrhea with tenesmus (a feeling of incomplete defecation accompanied by straining), all belong to Heat. Flowing water does not rot; moving objects do not become infested with worms. Therefore, vomiting and acid regurgitation occur because excessive Heat in the Stomach and Diaphragm causes Qi stagnation, preventing food from digesting properly and turning it sour. Sourness is the flavor associated with Liver Wood. It is erroneous to claim that vomiting acid belongs to Cold. "Sudden diarrhea" refers to rapid purging, which results from intestinal and gastric Heat disrupting normal transportation and transformation. The Classic states: "When Clear Yang fails to ascend and remains below, it generates stool containing undigested food." Tenesmus refers to a sense of urgency and heaviness in the rectum, along with cramping abdominal pain. This is due to the swift nature of Fire, which possesses the capacity to generate and transform things. Commonly referred to as "straining while sitting empty" (frequent urge to defecate with little output) accompanied by pain.

Various manifestations of roughness, dryness, witheredness, tension, wrinkling, and skin fissuring all belong to Dryness. Roughness and witheredness arise from a deficiency of body fluids and Qi, causing Blood to fail to nourish the skin and flesh, and Qi to flow unsmoothly. Consequently, the skin becomes wrinkled, fissured, and rough. If severe, numbness and loss of sensation may occur. Witheredness and dryness result from insufficient Yin (Water) and excessive Yang (Fire). The Commentary on the Appended Phrases states: "Nothing dries up the myriad things more than Fire." Thus, when Fire reaches extreme heat, body fluids are depleted and fail to moisten the body, causing the skin to crack. The hands and feet may appear as if cut by an axe, with wounds two or three fen deep. These symptoms worsen in winter and improve in summer. Therefore, the therapeutic principle states: Cold has a contracting effect; contraction leads to dryness, roughness, and fissuring. Heat has a relaxing effect; relaxation promotes nourishment and moisture. All these phenomena belong to the transformation of Dry Metal. Wang Bing’s commentary notes: Living things are smooth and lubricated; dead things are withered and rough. Treatment should aim to open pathways, nourish Yin, subdue Yang, and use cooling herbs to regulate. When Nutritive Blood flows freely, symptoms such as numbness, roughness, dryness, tension, and fissuring will resolve. One must strictly avoid administering Aconite (Fuzi) and similar warming drugs. The Classic states: The cycles of the Five Movements (Metal, Wood, Water, Fire, Earth) and the influences of the Six Qi (Cold, Summer-Heat, Dryness, Dampness, Fire, Wind) must adhere to their proper laws; only then can diseases among the people be regulated. All diseases suffered by humans fall under the principles of the excess, deficiency, and alternation of the Five Elements and Six Qi. Wang Bing’s commentary further states: Humans possess physical form and thus cannot be free from illness. Once illness exists, there are also ways to escape the cycle of generation and destruction, transcending Yin and Yang. Hence it is said: Carefully observe the pathogenesis and assign each condition to its corresponding category. Investigate the presence of symptoms; investigate the absence of symptoms. Address excess conditions by reducing them; address deficiency conditions by tonifying them. First, determine the dominance of any single Zang organ. Unblock the Qi and Blood, allowing them to flow smoothly and harmoniously, thereby achieving balance. This is what is meant.