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Heart governs fright. In excess, there is crying and shouting, fever, desire for water, and convulsions; in deficiency, there is palpitations and restlessness during sleep.
The Heart governs fright (Jing). In an Excess pattern, symptoms include crying and shouting, fever, thirst, and convulsions; in a Deficiency pattern, symptoms include palpitations and restlessness while sleeping.

Liver governs wind. In excess, there is staring eyes, loud crying, frequent yawning, neck stiffness, and sudden chest oppression; in deficiency, there is teeth grinding and frequent yawning. If Qi is hot, the pathogen arises externally; if Qi is cold, it arises internally (Bencao Gangmu adds "wind" after both "arises externally" and "arises internally").
The Liver governs Wind (Feng). In an Excess pattern, symptoms include fixed gaze, loud crying, frequent yawning, neck stiffness, and sudden chest distress; in a Deficiency pattern, symptoms include bruxism (teeth grinding) and frequent yawning. If internal heat prevails, the condition manifests externally; if internal cold prevails, it manifests internally.

Spleen governs lethargy. In excess, there is drowsiness, body heat, and thirst; in deficiency, there is vomiting, diarrhea, and generation of wind.
The Spleen governs fatigue/lethargy. In an Excess pattern, symptoms include drowsiness, feverish sensation, and thirst; in a Deficiency pattern, symptoms include vomiting, diarrhea, and the generation of Internal Wind.

Lung governs panting. In excess, there is chest oppression, confusion, and rapid breathing, with some patients desiring water and others not; in deficiency, there is throat obstruction and long sighs.
The Lung governs asthma/panting. In an Excess pattern, symptoms include chest oppression, mental agitation, and dyspnea, with varying degrees of thirst; in a Deficiency pattern, symptoms include a sensation of obstruction in the throat and frequent long sighing.

Kidney governs deficiency and has no excess; only in cases of smallpox/varicella, if Kidney excess occurs, the lesions turn black and sink.
The Kidney primarily manifests as Deficiency and does not typically present with Excess patterns; however, in cases of eruptive diseases like smallpox or chickenpox, if Kidney Excess occurs, the lesions may turn black and become depressed.

One must further distinguish between Excess and Deficiency patterns. For example, if Lung disease presents with Liver signs such as frequent yawning involving the incisors, it is easy to treat because Liver Qi is deficient and cannot overcome Lung Qi. If there is staring eyes, loud crying, neck stiffness, and sudden chest oppression, it is difficult to treat because prolonged Lung disease leads to Lung Qi deficiency and cold, allowing strong Liver Excess to counter-act and overcome the Lung. Treatment should be based on the newness or chronicity and the Excess or Deficiency of the disease: tonify the Mother organ in Deficiency, and drain the Child organ in Excess.
It is essential to further differentiate between Excess and Deficiency patterns. For instance, if Lung pathology presents with Liver signs, such as frequent yawning associated with the incisors, the prognosis is favorable because Liver Qi is deficient and fails to control Lung Qi. Conversely, if symptoms include fixed gaze, loud crying, neck stiffness, and sudden chest distress, the prognosis is poor because chronic Lung disease results in Lung Qi deficiency and cold, allowing robust Liver Excess to overact upon the Lung. Treatment depends on whether the disease is acute or chronic and whether it is Excess or Deficiency: tonify the Mother organ in Deficiency patterns, and drain the Child organ in Excess patterns.

Liver disease presents with crying, shouting, fixed gaze, yawning, chest oppression, and neck stiffness.
Liver disease presents with crying and shouting, fixed gaze, yawning, chest oppression, and neck stiffness.

Heart disease presents with frequent crying, shouting, fright, palpitations, trembling of hands and feet, fever, and thirst.
Heart disease presents with frequent crying and shouting, fright, palpitations, tremors of the limbs, fever, and thirst.

Spleen disease presents with lethargy, drowsiness, diarrhea, and anorexia.
Spleen disease presents with lethargy, drowsiness, diarrhea, and loss of appetite.

Lung disease presents with chest oppression, mental agitation, throat obstruction, long sighs, shortness of breath, and rapid panting.
Lung disease presents with chest oppression, mental agitation, a sensation of throat obstruction, frequent long sighing, shortness of breath, and rapid breathing.

Kidney disease presents with dull eyes lacking luster, photophobia, and heaviness of the body and bones.
Kidney disease presents with eyes that are dull and lack luster, photophobia, and a sensation of heaviness in the body and bones.

[Li Dongyuan] Heat originates from the Heart, cold from the Kidney, cough with rebellious Qi from the Lung, wind from the Liver, and diarrhea from the Spleen. If diarrhea is accompanied by cough and rebellious Qi, it is a Spleen-Lung disease, and Xiebai San combined with Yihuang San should be taken, because the Spleen dislikes dampness and the Lung dislikes dryness with rebellious Qi. If diarrhea is accompanied by sallow complexion and audible borborygmi, Lizhong Tang is indicated. If diarrhea is accompanied by vomiting, Fuling Banxia Tang is indicated. If diarrhea is accompanied by thirst and significant heat, Huangqin Houpo Tang is indicated. If there is no thirst and mild heat, Baizhu Houpo Tang is indicated. Other Zang organs with mixed symptoms can be deduced similarly. Refer to the subsequent discussion for detailed medication adjustments according to the four seasons.
[Li Dongyuan] Heat syndromes originate from the Heart, cold syndromes from the Kidney, cough with rebellious Qi from the Lung, wind syndromes from the Liver, and diarrhea from the Spleen. If diarrhea is concurrent with cough and rebellious Qi, it indicates a Spleen-Lung disorder; Xiebai San (White Powder Decoction to Drain) combined with Yihuang San (Yellow-Empowering Powder) should be administered, as the Spleen dislikes dampness and the Lung dislikes dryness with rebellious Qi. If diarrhea presents with a sallow complexion and prominent borborygmi, Lizhong Tang (Regulate the Middle Decoction) is appropriate. If diarrhea is accompanied by vomiting, Fuling Banxia Tang (Poria and Pinellia Decoction) is appropriate. If diarrhea is accompanied by thirst and marked heat, Huangqin Houpo Tang (Scutellaria and Magnolia Bark Decoction) is appropriate. If there is no thirst and mild heat, Baizhu Houpo Tang (Atractylodes Macrocephala and Magnolia Bark Decoction) is appropriate. Mixed symptoms in other Zang organs can be inferred by analogy. For detailed medication strategies adjusted according to the four seasons, refer to the subsequent discussions.

If Liver disease appears in Autumn (or at dusk), it indicates Liver overcoming Lung. Since Lung Qi is weak and cannot overcome Liver, one should tonify the Spleen to treat the Liver. Tonifying the Spleen makes the Child solid via the Mother relationship. Use Yihuang San to tonify the Spleen and Xieqing Wan to treat the Liver. If Lung disease appears in Spring (or in the morning), it indicates Lung overcoming Liver. Since Liver Qi is weak, it becomes diseased. One should tonify the Liver and Kidney to treat the Lung. Use Dihuang Wan to tonify the Liver and Kidney and Xiebai San to treat the Lung. If Liver disease appears in Autumn, Wood is prosperous, and Liver overcomes Lung. One should tonify the Lung and drain the Liver. Mild cases resolve; severe cases result in white lips and death. If Lung disease appears in Spring, Metal is prosperous, and Lung overcomes Liver. One should drain the Lung. Mild cases resolve; severe cases result in pale blue eyes, inevitable fright, and possibly redness leading to convulsions (Zhang Yuansu says: this is due to Liver weakness, hence the pale blue eyes). If Heart disease appears in Winter, Fire is prosperous, and Heart overcomes Kidney. One should tonify the Kidney and treat the Heart. Mild cases resolve; severe cases result in downward wandering and muteness due to Kidney weakness. If Kidney disease appears in Summer, Water overcomes Fire, and Kidney overcomes Heart. One should drain the Kidney. Mild cases resolve; severe cases result in palpitations and convulsions. Spleen disease appearing in other seasons/directions follows this logic. Smooth interactions are easy to treat; adverse ones are difficult. Spleen weakness presents with red-yellow face and eyes. Treat contrary Five Zang interactions according to symptoms.
If Liver pathology manifests in Autumn (or during the evening hours), it signifies Liver Qi overcoming Lung Qi. Because Lung Qi is deficient and unable to control Liver, treatment should focus on tonifying the Spleen to address the Liver issue. Tonifying the Spleen strengthens the Child organ through the Mother relationship. Yihuang San (Yellow-Empowering Powder) should be used to tonify the Spleen, and Xieqing Wan (Green-Draining Pill) to treat the Liver. If Lung pathology manifests in Spring (or in the morning), it signifies Lung Qi overcoming Liver Qi. The Liver becomes diseased due to its weakness. Treatment should involve tonifying the Liver and Kidney to address the Lung. Dihuang Wan (Rehmannia Pill) should be used to tonify the Liver and Kidney, and Xiebai San (White Powder Decoction to Drain) to treat the Lung. If Liver pathology appears in Autumn, when Wood energy is vigorous, Liver overacts on Lung. One should tonify the Lung and drain the Liver. In mild cases, the Liver condition resolves; in severe cases, the lips turn white, leading to death. If Lung pathology appears in Spring, when Metal energy is vigorous, Lung overacts on Liver. One should drain the Lung. In mild cases, the Lung condition resolves; in severe cases, the eyes appear pale blue, fright ensues, and if redness is present, convulsions occur (Zhang Yuansu states: this is due to Liver weakness, resulting in pale blue eyes). If Heart pathology appears in Winter, when Fire energy is vigorous, Heart overacts on Kidney. One should tonify the Kidney and treat the Heart. In mild cases, the Heart condition resolves; in severe cases, the child wanders downward and becomes mute due to Kidney deficiency. If Kidney pathology appears in Summer, when Water overcomes Fire and Kidney overacts on Heart, one should drain the Kidney. In mild cases, the Kidney condition resolves; in severe cases, palpitations and convulsions occur. Spleen pathology appearing in other seasons or directions follows this principle. Patterns following the generative cycle are easier to treat; those opposing it are more difficult. Spleen deficiency presents with a reddish-yellow complexion and eyes. Treat contrary Five Zang interactions according to the specific manifestations.

[Luo] The above discusses Five Zang mutual overcoming, where disease follows seasonal timing. This expands the intent of the *Neijing*’s chapter on Zang Qi and Seasonal Timing, truly developing insights previously unexpressed. For example, if Liver disease appears in Spring and morning, it is the Liver sick in its own position. Now appearing in Autumn and dusk (Lung’s position), it indicates extreme Lung deficiency with Liver overacting. Thus, one should tonify Spleen and Lung and drain Liver. Others follow this logic. [Zhang] When Liver overcomes Lung, Liver disease presents with fever and convulsions, plus Lung deficiency signs like wheezing and shortness of breath. Disease appearing in Shen-You-Xu hours indicates true Liver strength. *Neijing* states: "Being controlled but unable to control is called true strength." Method: tonify Spleen and Lung, drain Liver. Daoshi San and Xiehuang San are primary formulas.
[Luo Guizhong] The preceding text discusses the mutual overcoming of the Five Zang organs, where disease manifestation correlates with seasonal timing. This elaborates on the principles outlined in the *Huangdi Neijing*’s chapter on "Methods of Zang Qi According to Time," genuinely advancing theories not previously expounded. For instance, if Liver pathology manifests in Spring and morning, it represents the Liver being diseased in its proper domain. However, if it manifests in Autumn and dusk (times associated with the Lung), it indicates extreme Lung deficiency allowing Liver Qi to overact. Therefore, treatment should tonify the Spleen and Lung and drain the Liver. Similar logic applies to other scenarios. [Zhang Yuansu] When Liver overacts on Lung, Liver disease presents with fever and convulsions, accompanied by Lung deficiency signs such as wheezing and shortness of breath. Disease manifesting during the Shen, You, and Xu hours indicates genuine Liver excess. As stated in the *Neijing*: "To be constrained yet unable to constrain is termed 'True Strength'." The therapeutic method involves tonifying the Spleen and Lung while draining the Liver. Daoshi San (Guide Out the Red Powder) and Xiehuang San (Drain Yellow Powder) are the primary formulas.

Liu Zongnong said: These all concern Five Zang mutual overcoming, where disease mechanisms do not depart from the principles of Five Elements generation, restriction, and transformation. Infants in swaddling clothes have no seven emotions or six desires; they are merely physically fragile, with unsettled blood and Qi, and incomplete Zang-Fu spirit and essence. Thus, diseases of Zang Qi excess, deficiency, overcoming, and乘 (riding/oppressing) occur. Yet, common people do not understand this, often misdiagnosing these as external contraction or internal injury and prescribing accordingly, causing many wrongful deaths. Alas! Qian’s discussions had omissions, fortunately supplemented by Jiegu. Now specifically referencing and adding these, it is indeed a boundless benefit.
Liu Zongnong remarked: All these cases pertain to the mutual overcoming of the Five Zang organs, where the disease mechanism adheres strictly to the principles of Five Elements generation, restriction, and transformation. Infants within swaddling clothes lack the seven emotions and six desires; they are merely physically fragile, with unsettled Blood and Qi, and immature Zang-Fu spirits and essences. Consequently, disorders arising from the excess, deficiency, overacting, or oppressive relationships of Zang Qi occur. However, laypersons often fail to comprehend this principle, frequently misdiagnosing such conditions as external contractions or internal injuries and administering inappropriate medications, leading to numerous preventable deaths. How sorrowful! Although Qian Yi’s discussions contained some omissions, they were fortunately supplemented by Li Dongyuan (Jiegu) and Zhang Yuansu. By specifically incorporating and annotating their views here, this work offers an invaluable and enduring benefit.