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According to the *Nan Jing* (Classic of Difficult Issues), "To know through inquiry is called 'Gong' (a skilled physician)." A physician skilled in inquiry seeks the source of the disease based on current symptoms, determines the disease name, observes the location of the pathology, clarifies the condition, estimates the trend of the disease, and prevents complications. Here, one must first ask whether the patient feels thirsty. The Stomach is the sea of the twelve meridians; in the transmission of Shanghan (Cold Damage) diseases, pathogens inevitably return to the Yangming channel. The diagnosis and treatment of Shanghan entirely rely on the Yangming. To determine the cold or heat nature of interior syndromes (pathological changes within the internal organs), one must fully observe thirst or lack thereof. This is the essence of distinguishing Shanghan and constitutes the fifth major principle in diagnostic methods. Generally, for deficiency-cold syndromes, there is often no thirst; for excess-heat syndromes, there is often dryness and thirst. This is the normal pattern. Regarding variations: Those who prefer hot drinks usually have Phlegm-Fluids obstructing the middle jiao, or otherwise, Qi fails to transform into body fluids. Those who prefer cold drinks: if they drink large amounts, it indicates Fire pathogen seeking dryness (consuming body fluids); if they drink small amounts, it indicates Dampness transforming into Fire. Thirst caused by Yangming Excess-Heat manifests as great thirst with a desire to drink copiously. Thirst caused by Taiyin Damp-Heat manifests as thirst without a desire to drink much. Thirst caused by Shaoyin Deficiency-Heat manifests as dry mouth and thirst that does not resolve with water intake. Thirst caused by Jueyin Wind-Fire manifests as bitter taste in the mouth and thirst that resolves with water intake. Spontaneous diarrhea with thirst belongs to Yangming Heat-diarrhea; spontaneous diarrhea without thirst belongs to Taiyin Cold-diarrhea. Dryness of stomach fluids leading to desire to drink results in a preference for cold drinks and high volume intake. Water retention in the Bladder (water metabolism disorder) leading to desire to drink results in vomiting of ingested water and low volume intake. Thirst followed by vomiting indicates Water-Fluids stagnating below the heart (epigastrium). Vomiting followed by thirst indicates Fire scorching stomach fluids. Dry mouth accompanied by Xiao Ke (Wasting-Thirst syndrome characterized by polydipsia and polyuria) generally belongs to Liver-Stomach Heat disease. A neutral feeling in the mouth without thirst mostly belongs to Spleen-Kidney Cold syndromes.

The *Nei Jing* (Inner Canon) states: "Insufficiency of Middle Qi causes changes in urination and defecation." Such changes include: when Middle Qi is insufficient to resist Cold, urine becomes clear and cold; severely, the Bladder loses its restraining function leading to enuresis, and stool becomes loose or contains undigested food; severely, the intestines pour out directly causing severe watery diarrhea. When Middle Qi is insufficient to restrain Heat, urine becomes turbid; severely, Bladder Qi transformation fails leading to strangury (difficulty or inability to urinate), and stool becomes sticky, closed, and dry; severely, the intestines become stuck forming dysentery.

[Lian Kan's Note]: Observing urination and defecation is most emphasized in Western medicine diagnostics, as these excreta often contain fungi or micro-parasites. Chemical reagents are used to analyze them carefully to locate viruses. This diagnostic method is indeed worthy of emulation. Intestinal Cold leads to white urine; Intestinal Heat leads to yellow urine. Clear like cold water indicates Yin-Cold; turbid like rice wash water indicates Damp-Heat; red-yellow indicates Excess-Heat; pale yellow indicates Deficiency-Heat; deep red and old yellow indicates Hyperactive Liver-Yang; light red and pale yellow indicates Kidney-Yin Deficiency. Clear, long, and smooth urination indicates Heart-Yang Deficiency with sinking Kidney-Qi. Short, scanty, and painful urination indicates Excessive Heart-Fire and Heat knotting in the Bladder. Involuntary urination without awareness indicates a fatal condition. Excessive urination with vexation indicates a critical condition. Enuresis during sleep in children is called bedwetting, indicating Kidney and Bladder Deficiency-Cold. Freshly passed urine that is yellow-red and coagulates into a white paste-like substance after lying for a while is called "Ni Bai" (White Urine), indicating Liver-Heat forcing Kidney consumption. If the patient drinks one part and urinates one part, with color coagulating like white paste, sweet taste and odorless, it is Xia Xiao (Lower Wasting-Thirst) among the Three Xiao syndromes. Dribbling urination with urethral pain like knife-cutting indicates the Five Lin Syndromes (Sand, Stone, Blood, Grease, Labor Lin). Mild cases are Damp-Fire; severe cases are Lin-Toxin. Painless urination with color coagulating like paste, fine, white, and viscous indicates Jing Zhuo (Essence Turbidity); color like rice wash water, turbid and slippery, indicates Niao Zhuo (Urine Turbidity). The former is due to kidney injury from sexual activity; the latter is due to downward pouring of Damp-Fire. Sun-Tai accumulation of blood in the Bladder is verified by the patency or impatency of urine; Yang-Ming accumulation of blood in the intestines is verified by the blackness or non-blackness of stool. Generally, deficiency-cold syndromes present with loose or diarrheal stools; excess-heat syndromes present with dry and bound stools. Therefore, stool resembling duck feces and thin indicates Cold-Damp; stool resembling crab mud and sticky indicates Summer-Heat Damp. Diarrhea passing undigested food with a raw fishy smell indicates Yin-Cold; with a sour foul smell indicates Accumulated Heat. Green-colored, thin stool with strong raw fishy smell indicates Spleen-Kidney Deficiency-Cold; sticky juice with heavy foul smell indicates Liver-Gallbladder Excess-Heat. Old yellow stool indicates Excess-Heat; pale yellow indicates Deficiency-Heat. Red stool like peach pulp indicates Blood-Heat; black like glue/lacquer indicates Stasis-Heat. White stool belongs to Spleen Deficiency and also Gallbladder Jaundice. Sauce-colored belongs to Spleen Dampness and also intestinal mucus. Brown stool indicates heavy Fire; black stool indicates even heavier Fire. Sour-foul stool like spoiled vinegar indicates Food Stagnation; fishy-foul like rotten eggs indicates Milk Accumulation. Urgent defecation with sound indicates Small Intestine Heat; burning anal pain indicates Rectal Heat.

[Rong Zhai's Comment]: When asking about defecation, one should understand its consistency (loose/firm), quantity, color, and presence of blood or mucus. Ordinary diarrhea presents with loose (watery) stools in large quantities. Dysentery patients present with small amounts of stool containing blood, mucus, or pus. Cholera patients present with stools resembling rice washing water. Additionally, one should ask if there is pain during defecation, whether it is abdominal pain or anal pain, and if there is a sensation of "tenesmus" (Tense urgency with incomplete evacuation). (Tenesmus is a rectal sensation of wanting to defecate but being unable to pass stool, commonly seen in dysentery patients.)