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Whenever sinews are invaded by wind-heat pathogenic factors, they become flaccid and lax; when invaded by wind-cold pathogenic factors, they become spasmodic and tight. The sinews of the twelve meridians all originate from the fingers and toes of the hands and feet, and network throughout the body. In individuals with a weak constitution, wind-cold qi invades the interior, where cold qi stagnates and accumulates, forming knots, which is termed "Jiejin" (Sinew Knots).

The condition known as "Zhong'e" (Sudden Attack by Evil) occurs when a person's spirit is depleted and suddenly assaulted by the qi of ghosts or evil spirits. When a person's yin and yang are in harmony, and Ying (Nutritive) and Wei (Defensive) qi are balanced, the spirit remains steadfast, making the body strong so that pathogenic factors cannot invade the healthy qi. However, if proper care is neglected and the spirit becomes depleted, one may be struck by the toxic qi of ghosts. The manifestations include sudden stabbing pain in the heart and abdomen, severe distress, confusion, and a sensation of impending death. In cases of sudden Zhong'e with abdominal distension and fullness, if the pulse is tight, large, and floating, it indicates a fatal prognosis; if the pulse is tight, fine, and faint, it indicates survival.

Furthermore, in Zhong'e accompanied by hematemesis of several sheng, if the pulse is deep, rapid, and fine, it indicates a fatal prognosis; if the pulse is superficial, blazing, and rapid, it indicates survival. After recovering from Zhong'e, if residual pathogenic factors remain stagnant, subsequent attacks may transform into "Zhu" (Peripatetic Disease/Contagious Disease).

When attacked by the qi of ghostly pathogens, sudden severe cramping pain in the heart and abdomen with syncope and suffocation occurs. This is due to the violent excess of exogenous pathogens, causing difficulty in the connection of yin and yang, obstruction of upper and lower communication, leading to sudden rebellion and closure of qi, resembling death; after a long period, if true qi recovers, life is preserved. However, if one encounters the decline of the annual climate (Year of Decline), the emptiness of the lunar phase (Moon Emptiness), and disharmony of seasonal conditions, this is called "Sanxu" (Three Deficiencies). Under these three deficiencies, with weakened zang-fu organs and slightly emaciated spirit, invasion by pathogens leads to exhaustion of true qi and death. Those who recover, if residual pathogenic factors remain stagnant, may also transform into Zhu upon recurrence.

Shijue (Corpse-like Syncope) is caused by the rebellion of yin qi. It arises because yang meridians suddenly sink downward while yin meridians suddenly rise upward, causing separation of yin and yang, obstruction of Ying and Wei qi, disorder of true qi, and invasion by exogenous pathogens. The condition resembles death, yet there is still faint, irregular respiration, and although the pulse beats, the body is insensible. Listening near the ear reveals a whistling sound, and warmth in the groin area characterizes Shijue. Even without the whistling sound, if the pulse beats, it should be treated as Shijue.

Palpating the Cun Kou (Radial Pulse), if the pulse is deep, large, and slippery: deep indicates excess, slippery indicates qi stagnation; the struggle between excess and qi stagnation results in a warm body with sweating. This indicates the pathogen has entered the Fu organs; although sudden syncope with loss of consciousness occurs, self-recovery follows upon restoration of qi. If the lips are cyanotic and the body is cold, this indicates the pathogen has entered the Zang organs; similarly involving sudden syncope and loss of consciousness, but resulting in immediate death. Palpating the Guan position on the left hand: if both yin and yang pulses are deficient, it indicates deficiency of the Foot Jueyin Liver Meridian and Foot Shaoyang Gallbladder Meridian. The patient suffers from mental confusion, Shijue with loss of consciousness, and visual hallucinations.