悸，渴而妄冒，此又火之所以有虚实也。瞀音茂。螈音翅。”）诸厥固泄，皆属于下。（“厥，逆也。厥有阴
阳二证∶阳衰于下则为寒厥，阴衰于下则为热厥。固，前后不通也，阴虚则无气，无气则清浊不化，寒闭也。
火盛则水亏，水亏则精液干涸，热结也。泄，二阴不固也，命门火衰，则阳虚不禁，寒泄也。命门水衰，则火
迫注遗，热泄也。下言肾气，盖肾居五脏之下，为水火阴阳之宅，开窍于二阴，故诸厥固泄，皆属于下。”）
诸痿喘呕，皆属于上。（“痿有筋、肉、脉、骨痿之辨，故曰诸痿。凡肢体痿弱多在下部，而曰属于上者，如
痿论云∶‘五脏使人痿者，因肺热叶焦，发为痿 也。’肺居上焦，故属于上。气急曰喘，病在肺也。吐而有
物有声曰
呕，病在胃口也。逆而不降，是皆上焦之病。”）诸禁鼓栗，如丧神守，皆属于火。（“禁，噤也，寒厥切牙曰噤。
鼓，鼓颔也。栗，战也。凡病寒战而精神不能主持，如丧失神守者，皆火之病也。然火有虚实之辨，若表里热
甚而外生寒栗者，如阴阳应象大论所谓热极生寒，重阳必阴也，河间曰，心火热甚，亢极而战，反兼水化制之，
故为寒栗者，皆言火之实也。若阴盛阳虚而生寒栗者，如调经论曰，阳虚畏外寒，刺节真邪论曰，阴胜则为寒，
寒则真气去，去则虚，虚则寒搏于皮肤之间者，皆言火之虚也。有伤寒将解而为战汗者，如仲景曰，其人本虚，
是以作战，成无己曰，战栗者阴阳之争也，伤寒欲解将汗之时，正气内实，邪不能与之争，则便汗出而不发战，
邪气欲出，其人本虚，邪与正争，微者为振，甚者为战，皆言伤寒之战汗，必因于虚也。有 疟之为寒栗者，
如疟论曰，疟之始发也，阳气并于阴，当是之时，阳虚而阴盛，外无气，故先寒栗也，夫疟气者，并于阳则阳
胜，并与阴则阴胜，阴胜则寒，阳胜则热，又曰，阳并于阴则阴实而阳虚，阳明虚则寒栗鼓颔也。由此观之，
可见诸禁鼓栗虽皆属火，但火实者少，火虚者多耳。”）诸痉项强，皆属于湿。（“痉，风强病也。项为足之
太阳，湿兼风化而侵寒水之经，湿之极也。然太阳所至，为屈伸不利，太阳之复，为腰 反痛，屈伸不便者，是
又为寒水反胜之虚邪矣。痉音敬。”）诸逆冲上，皆属于火。（“火性炎上，故诸逆冲上者皆属于火。然诸脏
诸经皆有逆气，则其阴阳虚实有不同矣。其在心脾胃者，如脉解篇曰，太阴所谓上走心为噫者，阴盛而上走于
阳明，阳明络属心，故曰上走心为噫也。有在肺者，如脏气法时论曰，肺苦气上逆也。有在脾者，如经脉篇曰，
足太阴厥气上逆，则霍乱也。有在肝者，如脉要精微论曰，肝脉若搏，令人喘逆也。有在肾者，如脉解篇曰，少
阴所谓呕咳上气喘者，阴气在下，阳气在上，诸阳气浮，无所倚从也，又缪刺篇曰，邪客于足少阴之络，令人
无故善怒，气上走贲上，又示从容论曰，咳喘烦冤者，是肾气之逆也，又邪气脏腑病形篇曰，肾脉微缓为洞，
洞者食不化，下咽还出也。有在胃者，如宣明五气篇曰，胃为气逆为哕也，又阴阳别论曰，二阳之病发心脾，
其传为息贲
也。有在胆胃者，如四时气篇曰，善呕，呕有苦，长太息，心中 ，恐人将捕之，邪在胆，逆在胃也。有在
小肠者，曰少腹控睾，引腰脊，上冲心也。有在大肠者，曰腹中常鸣，气上冲胸，喘不能久立也，又缪刺论曰，
邪客手阳明之络，令人气满胸中喘息也。有在膀胱者，如经脉别论曰，太阳脏独至，厥喘虚气逆，是阴不足，阳
有余也。有在冲督者，如骨空论曰，冲脉为病，逆气里急，督脉生病，从少腹上冲心而痛，不得前后，为冲疝也。
凡此者皆诸逆上冲之病，虽经言皆属于火，但阳盛者火之实，阳衰者火之虚，治分补泻，当于此详察之矣。”）
诸胀腹大，皆属于热。（“热气内盛者，在肺则胀于上，在脾胃则胀于中，在肝肾则胀于下，此以火邪所至，
乃为烦满，故曰诸胀腹大，皆属于热。如岁火太过，民病胁支满，少阴司天，肺 ，腹大满，膨膨而喘咳，少阳
司天，身面 肿，腹满仰息之类，皆实热也。然岁水太过，民病腹大胫肿，岁火不及，民病胁支满，胸腹大，流
衍之纪，其病胀，水郁之发，善厥逆，痞坚腹胀，太阳之胜，腹满食减，阳明之复，为腹胀而泄，又如五常政
大论曰，适寒凉者胀，异法方宜论曰，脏寒生满病，经脉篇曰，胃中寒则胀满，是皆言热不足，寒有余也。仲景
言腹满不减，减不足言，须当下之，宜与大承气汤，言实胀也。腹胀时减，复如故，此为寒，当与温药，言虚胀
也。东垣曰，大抵寒胀多，热胀少，岂虚语哉。故治此者，不可以诸胀腹大，悉认为实热，而不察其盛衰之义也。”）
诸躁狂越，皆属于火。（“躁，烦躁不宁也。狂，狂乱也。越，失常度也。热盛于外则肢体躁扰，热盛于内则神志
躁烦，盖火入于肺则烦，火入于肾则躁，烦为热之轻，躁为热之甚耳。如少阴之胜，心下热，呕逆躁烦，少阳之
复，心热烦躁，便数憎风之类，是皆火盛之躁也。然有所谓阴躁者，如岁木太过，寒气流行，邪害心火，民病心热
烦心躁悸，阴厥谵妄之类，阴之胜也，是为阴盛发躁，名曰阴躁，成无己曰，虽躁欲坐井中，但欲水不得入口是也。
东垣曰∶阴躁之极，欲坐井中，阳已先亡，医犹不悟，复指为热重，以寒药投之，其死也何疑焉，盖寒凉之剂入腹，
周身之火得水则升走矣。且凡内热而躁者，有邪之热也，病多属火，外热而躁者，无根，病多属寒，此所以
热躁宜寒，阴躁宜热也。狂，阳病也，宣明五气篇曰，邪入于阳则
狂，难经曰，重阳者狂，如赫曦之纪，血流狂妄之类，阳狂也。然复有虚狂者，如本神篇曰，肝悲哀动中则伤
魂，魂伤则狂妄不精，肺喜乐无极则伤魄，魄伤则狂，狂者，意不存人，通天论曰，阳重脱者阳狂，腹中论曰，
石之则阳虚，虚则狂，是又狂之有虚实，补泻之不可误用也。”）诸暴强直，皆属于风。（“暴，猝也。强直，
筋病强劲不和柔也。肝主筋，其化风，风气有余，如木郁之发，善暴僵仆之类，肝邪实也。风气不足，如委和
之纪，其动 戾拘缓之类，肝气虚也。此皆肝木本气之化，故曰属风，非外来虚风八风之谓。凡诸病风而筋为
强急者，正以风位之下，金气乘之，燥逐风生，其燥益甚，治宜补阴以制阳，养营以润燥，故曰治风先治血，血
行风自灭，此最善之法也。设误认为外感之邪，而用疏风愈风等剂，则益燥其燥，非惟不能去风，而适所以致
风矣。”）诸病有声，鼓之如鼓，皆属于热。（“鼓之如鼓，胀而有声也，为阳气所逆，故属于热。然师傅篇
曰，胃中寒则腹胀，肠中寒则肠鸣飧泄，口问篇曰，中气不足，肠为之苦鸣，此又皆寒胀之有声者也。”）诸
病肿，疼酸惊骇，皆属于火。（“ 肿，浮肿也。 肿疼酸者，阳实于外，火在经也。惊骇不宁者，热乘阴
分，火在脏也。故如少阴少阳司天，皆为疮疡 肿之类，是火之实也。然伏明之纪，其发痛，太阳司天，为
肿身后痈，太阴所至为重 肿，太阳在泉，寒复内余，则腰尻股胫足膝中痛之类，皆以寒湿之胜而为肿为痛，
是又火之不足也。至于惊骇，虚实亦然，如少阴所至为惊骇，君火盛也。若委和之纪，其发惊骇，阳明之复，
亦为惊骇，此又以木衰金胜，肝胆受伤，火无生气，阳虚所致，当知也。 音附。”）诸转反戾，水液混浊，
皆属于热。（“诸转反戾，转筋拘挛也。水液，小便也。河间曰，热气燥烁于筋，则挛螈为痛，火主燔灼燥动
故也，小便混浊者，天气热则水混浊，寒则清洁，水体清而火体浊故也，又如清水为汤，则自然浊也，此所谓
皆属于热，宜用寒者是也。然其中亦各有虚实之不同者，如伤暑霍乱而为转筋之类，宜用甘凉调和等剂清其亢
烈之火者，热之属也。如感冒非时风寒，或因豪雨之后，湿毒中脏而为转筋霍乱，宜用辛温等剂理中气以逐阴
邪者，寒之属也。大抵热
胜者必多烦躁焦渴，寒胜者必多厥逆畏寒。故太阳之至为痉，太阳之复为腰 反痛屈伸不便，水郁之发为大关
节不利，是皆阳衰阴胜之病也。水液之浊，虽为属火，然思虑伤心，劳倦伤脾，色欲伤肾，三阴亏损者多有是病，
治宜慎起居，节劳欲，阴虚者壮其水，阳虚者益其气，金水既足，盒饭自清，若用苦寒，病必益甚，故玉机真
脏论曰，冬脉不及，则令人少腹满，小便变，口问篇曰，中气不足，溲便为之变，阴阳盛衰，义有如此，又岂可
尽以前证为实热。”谨按三阴亏损之人，便多混浊者何？盖由阴虚水亏，不胜制火，火愈盛则水愈亏，故令色
黄赤而混浊，如汪洋之水必澄清，沟渠之水必混浊也。俗医不识阴阳虚实之理，但见混浊，便用苦寒，以致真气
冰凝，不能化水，孤阳无制而死，殊可叹也！）诸病水液澄彻清冷，皆属于寒。（“水液者，上下所出皆是也。
水体清，其气寒，故凡或吐或利，水谷不化而澄彻清冷者，皆得寒水之化，如秋冬寒冷，水必澄清也。”）诸呕
吐酸，暴注下迫，皆属于热。（“河间曰∶胃膈热甚则为呕，火气炎上之象也。酸者，肝木之味也，由火盛制金，
不能平木，则肝木自甚，故为酸也。暴注，卒暴注泄也，肠胃热甚而传化失常，火性疾速故如是也。下迫，后重
里急窘迫急痛也，火性急速而能燥物故也。是皆就热为言耳，至于阴阳盛衰，则变如冰炭，胡可偏执为论。如举
病论曰∶寒气客于肠胃，厥逆上出，故痛而呕也，至真要等论曰，太阳司天，民病呕血善噫，太阳之复，心胃生
寒，胸中不和，唾出清水，及为哕噫，太阳之胜，寒入下焦，传为濡泄之类，是皆寒胜之为病也。又如岁木太过，
民病飧泄肠鸣，反胁痛而吐甚，发生之纪，其病吐利之类，是皆木邪乘土，脾虚病也。又如岁土不及，民病飧泄霍
乱，土郁之发为呕吐注下，太阴所至为霍乱吐下之类，是皆湿胜为邪，脾家本病，有湿多成热者，有寒湿同气者，
湿热宜清，寒湿宜温，无失气宜，此之谓也。至于吐酸一证，在本节则明言属热，又如少阳之胜为呕酸，亦相火
证也，此外别无因寒之说。惟东垣曰∶呕吐酸水者，甚则酸水浸其心，其次则吐出酸水，令上下牙酸涩不能相对，
以大辛热剂疗之必减。酸味者收气也，西方肺金旺也，寒水乃金之子，子能令母实，故用大咸热之剂泻其子，以
辛热为之佐，以泻肺之实，若以河间病机之法作热
攻之者误矣。盖杂病酸心，浊气不降，欲为中满，寒药岂能治之乎。此东垣之说，独得前人所未发也。又丹溪
曰∶或问∶吞酸素问明以为热，东垣又以为寒，何也？曰∶素问言热者言其本也，东垣言寒者言其末也。但东垣不
言外得风寒，而作收气立说，欲泻肺金之实，又谓寒药不可治酸，而用安胃汤、加减二陈汤，俱犯丁香，且无
治热湿郁积之法，为未合经旨。余尝治吞酸，用黄连茱萸各制炒，随时令迭为佐使，苍术茯苓为辅，汤浸蒸饼
为小丸吞之，仍教以 食蔬果自养，则病亦安。此又二公之说有不一也，若以愚见评之，则吞酸虽有寒热，但
属寒者多，属热者少，故在东垣则全用温药，在丹溪虽用黄连，而亦不免茱萸苍术之类，其义可知。盖凡饮留
中焦，郁久成积，湿多生热，则木从火化，因而作酸者，酸之热也，当用丹溪之法。若客寒犯胃，顷刻成酸，
本非郁热之谓，明是寒气，若用清凉，岂其所宜。又若饮食或有失节，及无故而为吞酸嗳腐等证，此以木味为邪，
肝乘脾也，脾之不化，火之衰也，得热则行，非寒而何，欲不温中，其可得乎。故余愿为东垣之左HT ，而特表
出之，欲人之视此者，不可谓概由乎实热。”仅按病机一十九条，所言多是火热，其属寒者，才一条耳。详味
经旨，非偏实热而略虚寒也，盖以人之为病，多由六淫，即或内虚，无感不发，是风火寒湿者，乃致病之机栝，
故曰病机也。病机既肇，变化无穷矣，或实或虚，或热或寒，或真热而假寒，或真寒而假热，此固非本条之所
能尽载，而杂见于诸篇，惟恃善治者为能参观而互用之也。乃完素但顺文解释，以致后人有诸病皆起于火之说。
惟景岳以经解经，使虚实寒热之理，并行而不背，可谓旁通曲畅矣，但于病机所言，偏于实热之故，尚未拈出，
以故深咎夫刘氏而愿左HT 东垣也，悲夫！）故大要曰∶谨守病机，各司其属，有者求之，无者求之，盛者责之，
虚者责之，必先五胜，疏其血气，令其调达，而致和平。此之谓也。（深乎圣人之言，理宜然也。有无求之，
虚盛责之，言悉由也。夫如大寒而甚，热之不热，是无火也。热来复去，昼见夜伏，夜发昼止，时节而动，是
无火也。当助其心。又如大热而甚，寒之不寒，是无水也。热动复止，倏忽往来，时动时止，是无水也。当助
其肾。内格呕逆，食不得入，是有火
Palpitations, thirst, and delirious confusion demonstrate the distinction between deficiency and excess of Fire. Mao (mào, visual obscuration or mental confusion). Yu (yú, convulsions)." All cases of Jue (reversal/cold extremities), constipation/obstruction, and incontinence/diarrhea belong to the Lower Jiao (Lower Burner/Kidney region). ("Jue refers to counterflow Qi. Jue syndrome is divided into Yin and Yang types: Yang deficiency in the lower part leads to Cold Jue, while Yin deficiency in the lower part leads to Heat Jue. 'Gu' refers to obstruction of urination and defecation. Yin deficiency leads to lack of Qi; without Qi, clear and turbid substances fail to transform, resulting in cold closure. Excessive Fire depletes Water; depleted Water leads to dryness of essence and fluids, resulting in heat accumulation. 'Xie' refers to incontinence due to failure of the two yin openings. Decline of Mingmen Fire leads to Yang deficiency and inability to hold, causing cold diarrhea. Decline of Mingmen Water leads to Fire forcing leakage, causing heat diarrhea. The term 'lower' here refers to Kidney Qi, as the Kidneys reside below the five Zang organs and are the residence of Water and Fire, Yin and Yang, opening into the two yin openings. Therefore, all cases of Jue, obstruction, and incontinence belong to the lower.") All cases of Wei (wasting-flaccidity) syndromes, Chuan (asthma/panting), and Ou (vomiting) belong to the Upper Jiao (Upper Burner/Lung-Stomach region). ("Wei syndromes include tendon, muscle, vessel, and bone wasting, hence termed 'all Wei'. Although limb flaccidity often occurs in the lower body, it is said to belong to the upper because the *Lun Wei* states: 'Dysfunction of the five Zang organs can cause Wei syndromes, specifically due to Lung Heat causing the leaves to wither and burn, leading to Wei.' The Lung resides in the Upper Jiao, hence it belongs to the upper. Rapid breathing is called Chuan, with pathology in the Lung. Vomiting with sound and matter is called Ou, with pathology in the stomach area. Counterflow Qi failing to descend indicates these are diseases of the Upper Jiao.") All cases of Jin (clenched jaw/stiffness), Gu Han (shivering/chattering teeth), Li (trembling), and loss of spiritual control belong to Fire. ("Jin refers to clenched jaw; biting teeth tightly during Cold Jue is called Jin. Gu refers to chattering teeth. Li refers to trembling/shivering. Any disease involving cold shivering where the spirit cannot maintain control, resembling a loss of spiritual guardianship, belongs to Fire pathology. However, Fire has deficiency and excess distinctions. If extreme internal/external heat generates external cold shivering, as stated in *Yin Yang Ying Xiang Da Lun*: 'Extreme heat generates cold, extreme Yang becomes Yin,' and Liu Hejian's view that excessive Heart Fire reaching extreme levels triggers a water-like reaction to restrain it, causing cold shivering, this refers to Excess Fire. If cold shivering arises from Yin excess and Yang deficiency, as stated in *Tiao Jing Lun*: 'Yang deficiency fears external cold,' and *Ci Jie Zhen Xie Lun*: 'Yin excess leads to cold; cold causes true Qi to depart; departure leads to deficiency; deficiency leads to cold stagnating in the skin,' this refers to Deficient Fire. In Shaoyin disorders resolving via sweating after shaking (Zhan Han), Zhang Zhongjing states: 'The patient is originally deficient, hence they shake.' Cheng Wuji states: 'Shaking is a struggle between Yin and Yang.' When Shaoyin resolves and sweat is about to occur, if interior Zheng Qi is solid, pathogenic factors cannot contend, so sweat occurs without shaking. If pathogens exit but the patient is originally deficient, pathogens contend with Zheng Qi; mild contention causes tremors, severe contention causes shaking. This refers to Shaoyin Zhan Han, which must be due to deficiency. In Malaria causing cold shivering, as stated in *Lun Mai*: 'At onset, Yang merges into Yin; at this time, Yang is deficient and Yin is excess, lacking exterior Qi, hence initial cold shivering.' Malarial Qi merging into Yang causes Yang excess; merging into Yin causes Yin excess. Yin excess brings cold; Yang excess brings heat. Also: 'Yang merging into Yin makes Yin solid and Yang deficient; Yangming deficiency causes cold shivering and chattering teeth.' Thus, although all cases of Jin, Gu Han, and Li belong to Fire, Excess Fire is rare, while Deficient Fire is common." All cases of Jing (spasm/stiffness) and neck stiffness belong to Dampness. ("Jing refers to wind-induced stiffness. The neck belongs to the Foot Taiyang Bladder channel. Dampness combining with Wind invades the Cold-Water channel, representing extreme Dampness. However, Taiyang arrival causes difficulty in flexion and extension; Taiyang reversal causes lumbar rigidity and inability to move, indicating another type of empty evil from reverse winning by Cold-Water. Jing (jìng, spasm).") All cases of Ni Chong Shang (counterflow rushing upward) belong to Fire. ("Fire nature is flaming upward, so all counterflow rushing upward belongs to Fire. However, all Zang and Jing meridians have counterflow Qi, differing in Yin/Yang and deficiency/excess. In Heart, Spleen, Stomach: *Mai Jie Pian* states Taiyin Qi moving up to the Heart causes belching; Yin excess moves to Yangming, whose collaterals connect to the Heart, hence belching. In Lung: *Zang Qi Fa Shi Lun* states Lung dislikes Qi counterflow. In Spleen: *Jing Mai Pian* states Foot Taiyang Jue Qi counterflow causes Huoluan. In Liver: *Mai Yao Jing Wei Lun* states surging Liver pulse causes panting and counterflow. In Kidney: *Mai Jie Pian* states Shaoyin vomiting, coughing, and panting result from Yin below and Yang above, with floating Yang lacking support. *Miao Ci Pian* states pathogen in Foot Shaoyin collateral causes anger and Qi rushing to Fen Shang. *Shi Cong Rong Lun* states cough, panting, and vexation indicate Kidney Qi counterflow. *Xie Qi Zang Fu Bing Xing Pian* states fine-slow Kidney pulse indicates Dong (loose stool/undigested food regurgitation). In Stomach: *Xuan Ming Wu Qi Pian* states Stomach Qi counterflow causes hiccups. *Yin Yang Bie Lun* states Er Yang disease originating in Heart/Spleen transmits to Xi Ben. In Gallbladder/Stomach: *Si Shi Qi Pian* states bitter vomiting, sighing, fear of capture indicates pathogen in Gallbladder, counterflow in Stomach. In Small Intestine: lower abdomen pulling testicles, waist/spine pain, Qi rushing to heart. In Large Intestine: borborygmus, Qi rushing to chest, panting unable to stand long. *Miao Ci Lun* states pathogen in Hand Yangming collateral causes chest fullness and panting. In Bladder: *Jing Mai Bie Lun* states Taiyang organ excess causes Jue, panting, and deficient Qi counterflow, indicating Yin insufficiency and Yang excess. In Chong/Du vessels: *Gu Kong Lun* states Chong vessel disease causes Qi counterflow and interior urgency; Du vessel disease causes Qi rushing from lower abdomen to heart with pain, inability to pass urine/feces, called Chong Hernia. These are all counterflow diseases. Though text says they belong to Fire, Yang excess is Fire Excess, Yang deficiency is Fire Deficiency. Treatment requires tonification or purgation, requiring careful examination.") All cases of Zhang Fu Da (distension and abdominal enlargement) belong to Heat. ("Internal Heat prosperity causes distension in Lung (upper), Spleen/Stomach (middle), Liver/Kidney (lower). Fire pathogen causes vexation and fullness, hence distension belongs to Heat. E.g., Year of Excess Fire causes hypochondriac fullness; Shao Yin ruling Heaven causes Lung oppression, abdominal fullness, panting/cough; Shao Yang ruling Heaven causes facial/body edema, abdominal fullness,仰息 (breathing with head thrown back)—all Excess Heat. Conversely, Year of Excess Water causes abdominal swelling and leg edema; Year of Insufficient Fire causes hypochondriac fullness, chest/abdominal distension; Liu Yan era causes distension; Water depression causes Jue, hardness, abdominal distension; Taiyang victory causes abdominal fullness, reduced appetite; Yangming reversal causes abdominal distension and diarrhea. *Wu Chang Zheng Da Lun* states cold induces distension; *Yi Fa Fang Yi Lun* states Cold-Zang causes fullness; *Jing Mai Pian* states Cold-Stomach causes distension—all indicating Heat insufficiency and Cold excess. Zhang Zhongjing: 'Abdominal fullness unrelieved requires purgation, use Da Cheng Qi Tang' (Excess Distension). 'Abdominal distension temporarily relieved then returns indicates Cold, use warming herbs' (Deficient Distension). Li Dongyuan: 'Generally, Cold distension is common, Heat distension is rare.' Thus, one must not assume all distension is Excess Heat without examining prosperity/deficiency.") All cases of Zao Kuang Yue (restlessness, mania, deviation) belong to Fire. ("Zao is restless agitation. Kuang is madness/deviation. Yue is losing normal measure. External Heat excess causes limb restlessness; Internal Heat excess causes mental agitation. Fire entering Lung causes Fan (vexation); Fire entering Kidney causes Zao (agitation). Fan is mild heat; Zao is severe heat. E.g., Shao Yin/Shao Yang heat causes heart-heat, vomiting, restlessness—Heat excess. However, there is Yin Zao (Yin-induced restlessness). E.g., Year of Excess Wood, Cold pathogen harms Heart Fire, causing heart-heat, vexation, palpitations, Yin Jue, delirium—Yin excess causing restlessness, named Yin Zao. Cheng Wuji: 'Though wanting to sit in a well, cannot drink water.' Li Dongyuan: 'Extreme Yin Zao, wanting to sit in a well, Yang is already extinct. If doctors mistake it for Heat and use Cold herbs, death is certain. Cold herbs cause remaining Fire to rise.' Internal Heat Zao is Pathogenic Heat (Fire); External Heat Zao is Rootless Heat (Cold). Hence Heat Zao uses Cold, Yin Zao uses Heat. Kuang is Yang disease. *Xuan Ming Wu Qi Pian*: 'Pathogen in Yang causes Kuang.' *Nan Jing*: 'Double Yang causes Kuang.' E.g., He Xi era blood flow madness is Yang Kuang. However, there is Deficient Kuang. *Ben Shen Pian*: Liver sorrow injures Hun (causing madness); Lung joy injures Po (causing madness). *Tong Tian Lun*: 'Extreme Yang depletion causes Yang Kuang.' *Fu Zhong Lun*: Stone drugs damage Yang, deficiency causes Kuang. Kuang has deficiency/excess; tonification/purgation must not be mistaken.") All cases of Bao Qiang Zhi (sudden stiffness/torticollis) belong to Wind. ("Bao is sudden. Qiang Zhi is tendon stiffness/lack of flexibility. Liver governs tendons, transforms into Wind. Excess Wind, e.g., Wood depression causing sudden collapse, is Liver Excess. Insufficient Wind, e.g., Wei He era causing cramping/relaxation, is Liver Deficiency. These are Liver Wood transformations, hence belonging to Wind, not external Eight Winds. For Wind diseases with tendon stiffness: Wind position is conquered by Metal Qi; Dryness drives Wind, increasing Dryness. Treatment should tonify Yin to restrain Yang, nourish Ying to moisten Dryness. 'To treat Wind, first treat Blood; when Blood flows, Wind extinguishes.' This is the best method. Mistaking it for external pathogen and using Wind-dispersing herbs increases Dryness and generates Wind.") All cases of sounds and drum-like percussion belong to Heat. ("Drum-like sound indicates distension with sound, caused by counterflow of Yang Qi, hence Heat. However, *Shi Chuan Pian* states Stomach Cold causes abdominal distension; Intestine Cold causes borborygmus and undigested stool; *Kou Wen Pian* states Middle Qi deficiency causes intestinal鸣 (sound). These are sounds from Cold distension.") All cases of Zhong (edema), Teng Suan (pain/soreness), Jing Hai (fright/terror) belong to Fire. ("Zhong is edema. Edema with pain/soreness indicates Yang excess externally, Fire in channels. Fright/terror indicates Heat invading Yin division, Fire in Zang. E.g., Shao Yin/Shao Yang ruling Heaven causes sores/ulcers/edema—Fire Excess. However, Fu Ming era causes pain; Taiyang ruling Heaven causes posterior abscesses; Taiyin causes heavy edema; Taiyang in泉 causes lumbar/buttock/thigh/knee pain—these are edema/pain from Cold-Damp excess, indicating Fire insufficiency. Fright/terror also varies. Shao Yin causes fright (Minister Fire excess). Wei He era and Yangming reversal cause fright due to Wood deficiency/Metal excess injuring Liver/Gallbladder, Fire lacking life Qi, Yang deficiency.") All cases of Zhuan Fan Li (twisting/spasms) and Hun Zhuo (turbid fluids) belong to Heat. ("Zhuan Fan Li refers to tendon spasms/cramps. Shui Ye refers to urine. Liu Hejian: Heat drying tendons causes spasms/pain; Fire burns/dries/moves. Turbid urine: hot weather makes water turbid, cold makes it clear; Water is clear, Fire is turbid. Like clear water boiling becomes turbid. Hence 'belong to Heat,' use Cold herbs. However, deficiency/excess exists. Summerheat-Huoluan spasms require Sweet-Cool harmonizing agents to clear fierce Fire (Heat type). Non-seasonal Wind-Cold or Rain-Damp toxicity causing Huoluan spasms require Pungent-Warm agents to regulate Middle Qi and expel Yin Evil (Cold type). Generally, Heat excess causes vexation/thirst; Cold excess causes Jue/cold aversion. Taiyang arrival causes Jing; Taiyang reversal causes lumbar rigidity; Water depression causes joint stiffness—all Yang deficiency/Yin excess. Turbid urine, though Fire-related, is common in Three Yin deficiency (Heart/Spleen/Kidney injury from worry/work/lust). Treatment: regulate lifestyle, moderate desires. Yin deficiency tonifies Water; Yang deficiency boosts Qi. When Metal/Water are sufficient, urine clears. Bitter-Cold herbs worsen it. *Yu Ji Zhen Zang Lun*: Winter pulse deficiency causes lower abdominal fullness, urine changes. *Kou Wen Pian*: Middle Qi deficiency causes urine/stool changes. One cannot assume all turbidity is Excess Heat. Note: Three Yin deficiency causes turbidity due to Yin/Water deficiency failing to control Fire; Fire excess depletes Water, causing yellow/red turbidity. Ocean water clarifies; ditch water turbid. Ignorant doctors use Bitter-Cold for turbidity, freezing True Qi, preventing fluid transformation, leaving isolated Yang unchecked—death ensues. Tragic!") All cases of Shui Ye Cheng Che Qing Leng (clear/cold fluids) belong to Cold. ("Shui Ye refers to all excretions. Water is clear, Qi is Cold. Vomiting/diarrhea of undigested food that is clear/cold reflects Cold-Water transformation, like autumn/winter water clarifying.") All cases of Ou Tu Suan (vomiting/acid regurgitation), Bao Zhu (sudden diarrhea), Xia Po (tenesmus) belong to Heat. ("Liu Hejian: Diaphragmatic Heat causes vomiting (Fire flaming up). Sour taste is Liver Wood flavor; Fire excess controls Metal, failing to control Wood, causing Wood excess and sourness. Bao Zhu is sudden diarrhea; Intestine/Stomach Heat disrupts transmission, Fire is rapid. Xia Po is tenesmus/urgency; Fire is rapid and drying. These describe Heat. However, Yin/Yang shifts vary. *Ju Tong Lun*: Cold in intestines/stomach causes counterflow vomiting/pain. *Zhi Yao Da Lun*: Taiyang ruling Heaven causes hematemesis/belching; Taiyang reversal causes Heart/Stomach Cold, chest discomfort, clear saliva, hiccups; Taiyang victory causes Cold in Lower Jiao leading to damp diarrhea—all Cold excess. Year of Excess Wood causes diarrhea/borborygmus/hypochondriac pain/vomiting (Wood attacking Earth, Spleen deficiency). Year of Insufficient Earth causes diarrhea/Huoluan; Earth depression causes vomiting/diarrhea; Taiyin causes Huoluan—all Dampness attacking Spleen. Dampness may become Heat or Cold. Heat-Damp needs clearing; Cold-Damp needs warming. Regarding acid regurgitation: this section says Heat. Shao Yang victory causes sour vomiting (Minister Fire). No Cold etiology mentioned except Li Dongyuan: Acid vomiting treated with Pungent-Hot herbs reduces symptoms. Sour is收敛 (astringent) Qi, West Lung Metal prosperous. Cold Water is Metal's child; Child strengthens Mother. Use Salty-Hot to drain Child, Pungent-Hot to assist, draining Lung Excess. Using Liu's Heat-method is error. Mixed disease acid stems from turbid Qi failing to descend, middle fullness; Cold herbs cannot treat. Dongyuan's insight is unique. Zhu Danxi asks: Suwen says Heat, Dongyuan says Cold? Answer: Suwen addresses root; Dongyuan addresses branch. But Dongyuan ignores external Wind-Cold, focuses on收敛 Qi to drain Lung. Uses An Wei Tang/Erxun Tang with Dingxiang, lacking Heat-Damp resolution. I treat acid with Huanglian/Zhuyu fried, Cangzhu/Fuling auxiliary, steamed pill, light diet. Discrepancy exists. My view: Acid is mostly Cold, rarely Heat. Dongyuan uses Warm; Danxi uses Huanglian but adds Zhuyu/Cangzhu. Drink retention in Middle Jiao, dampness generates Heat, Wood follows Fire → Acid Heat (Danxi's method). Guest Cold invading Stomach → instant Acid (Cold, not Heat-Damp). Dietary irregularity → Wood pathogen attacking Spleen, Fire deficiency → needs Warming Middle. I side with Dongyuan, warning against assuming all is Excess Heat.") Only 19 pathogenesis statements mention Fire/Heat; only one mentions Cold. Detailed reading shows bias toward Excess Heat ignoring Deficient Cold is incorrect. Disease arises from Six Evens; even internal deficiency requires pathogenic trigger. Wind/Fire/Cold/Damp are mechanisms. Pathogenesis starts, changes infinitely: Excess/Deficient, Heat/Cold, True/False. Not fully covered in one section, found in various chapters. Wang Hansu followed text literally, leading to "all diseases from Fire" theory. Zhang Jingyue interpreted classics mutually, balancing Excess/Deficient/Heat/Cold, achieving thorough understanding. Yet he didn't highlight why pathogenesis emphasizes Heat, thus criticizing Liu and siding with Dongyuan. Sad!)" Therefore, the *Da Yao* states: Carefully observe the pathogenesis, determine its affiliation. Investigate what is present, investigate what is absent. Blame excess, blame deficiency. First analyze the Five Victories (Wu Yun). Unblock Blood and Qi, ensure smooth flow, achieve harmony. This is the principle. (Profound are the Sage's words. Investigate presence/absence, blame excess/deficiency based on mechanism. E.g., Severe Cold unrelieved by Heat indicates no Fire; aid Heart. Heat unrelieved by Cold indicates no Water; aid Kidney. Interior rejection/vomiting preventing intake indicates Fire...)