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A pattern of cold in the exterior and heat in the interior arising when external evil passes into the interior and transforms into heat before the exterior cold has resolved. It can also arise in a condition of internal heat when cold evil is contracted. Exterior cold and interior heat patterns are characterized by aversion to cold, heat effusion, absence of sweating, and generalized pain. These signs may be accompanied by vexation and agitation, thirst, and constipation.

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