this is injury from cold entering the yang ming or shao yin stage where it transforms into heat. the heat battles with the water (controlled by the kidneys, the organ cor-responding to the leg shao yin channel), which leads to clumping of water and heat. heat also injures the yin (fluids) and disturbs the water pathways, resulting in urinary difficulty.

it is also common for this pattern to develop in patients with constitutional yin deficiency and invasion of heat into the lower jiao. heat gives rise to fever. injury to the fluids and obstruction of the water pathways causes thirst with a desire to drink (in contrast to thirst without a desire to drink, which is characteristic of damp-heat).

when fluids cannot be eliminated through the urine they are eliminated through the stool, resulting in diarrhea. if the disturbance of the water pathways affects the flow of qi in the lungs, there will be coughing. if the disturbance affects the middle burner, there will be nausea. vigorous heat due to yin deficiency agitates the heart and leads to irritability and insomnia.