This pattern represents a complex condition where an External Cold invasion coexists with blazing Internal Heat. This pattern starts with cold damage, often marked by symptoms like fever and chills, absence of sweating, headache, and sensations of heaviness and tightness, indicating severe greater Yang-warp cold damage.

As the condition progresses, signs of intense Internal Heat emerge. These include strong fever, redness of the face and eyes, dry nasal passages, thirst, irritability, insomnia, delirious speech, and a rapid pulse. These symptoms signal that the heat within the body has become excessive.

When this Internal Heat becomes extreme, it can lead to more severe manifestations, such as bleeding or skin blotches. This indicates that the Heat has disturbed the circulation of blood, causing it to move recklessly and manifest as these more serious symptoms. In TCM, this pattern requires careful balancing to clear the external cold while simultaneously cooling the Internal Heat to restore the body's equilibrium.