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When the deficiency and excess of the internal organs are not harmonious, external heat (Ke Re) arises. If wind-dampness exists on the exterior and contends with heat qi, sores will appear on the body, accompanied by itching, pain, and discharge of pus. In severe cases, the condition fluctuates between remission and exacerbation; this is caused by wind-heat pathogenic factors.

This occurs due to heat in the Spleen organ, which rushes upward to the Upper Jiao (the upper burner, encompassing the heart and lungs), resulting in sores in the mouth.

With excess in the upper part and deficiency in the lower part, abundant internal heat steams and scorches the throat, causing sores there.

After diaphoresis (sweating therapy), excessive sweating leads to a scarcity of Body Fluids (Jin Ye). A shortage of fluids causes dryness and stagnation in the Stomach, with heat residing within, thus leading to constipation. Additionally, some cases involve heat generated spontaneously by the internal organs; this stems from obstruction in the San Jiao (Triple Burner) and disharmony between the Spleen and Stomach, where heat accumulates internally, also resulting in constipation.

Heat in the Bladder flows into the Small Intestine. When heat is excessive, it dries the Spleen and Stomach and depletes fluids, leading to urinary retention.

Heat pathogens attack the intestines and stomach. If the Stomach Qi is deficient, red-yellow fluid is discharged; if mixed with toxins, it becomes pus and blood.

Heat pathogens attacking the intestines and stomach cause the decline of Gu Qi (Grain Qi/nutritive energy derived from food). Consequently, the "Three Worms" (intestinal parasites) become active, devouring the five zang organs and the lower orifices. In severe cases, anal erosion occurs, exposing the viscera.

The Liver opens into the eyes. When Liver Qi is deficient, heat-toxins take advantage of the deficiency to rush upward to the eyes. In severe cases, this results in sores, nebulae (corneal opacities), and red-white membranes.

Heat-toxin pathogens attack the hands and feet. The Jing-River points (Jing-Xue, Ying-Xue, Shu-Xue) of the five zang and six fu organs all emerge from the fingers and toes. Now, as toxin qi exits from the viscera and follows the meridians to attack the hands and feet, the fingertips become swollen, red, and painful.

Heat within the Stomach disrupts the harmony of Grain Qi. When new food enters the Stomach, it contends with the existing heat, disturbing Stomach Qi and causing vomiting. Alternatively, after vomiting or purging, visceral deficiency can also lead to vomiting.

Latent heat in the Stomach causes chest fullness. Chest fullness leads to rebellious Qi, and rebellious Qi causes hiccups (Yue). If, following severe purging, large amounts of water are consumed, the coldness and deficiency in the Stomach can also induce hiccups.

This is due to deficient heat in the five zang organs and disharmony between the Spleen and Stomach, leading to exhaustion and scarcity of fluids, resulting in a dry mouth.

This is caused by heat injuring the Heart. The Heart governs Blood, and the Lung governs Qi, opening into the nose. When evil heat combines with Blood and Qi, epistaxis (nosebleed) occurs. Epistaxis refers to blood flowing from the nasal cavity.

When a heat disease has just healed, fluids have not yet recovered, and Qi and Blood remain deficient. If one engages in labor too early, physical exertion generates heat. This heat takes advantage of the deficiency to re-enter the meridians, causing the recurrence of the disease.