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The *Yijing* (Book of Changes) states: From the Great Void to the Yellow Springs, Heaven and Earth have six levels. The *Neijing* (Inner Canon) states: The human body, from head to foot, also has six levels. Now I say: Between the chest and abdomen of a person, from the Lung to the Kidney, there are another six levels. Humans and Heaven and Earth, in their creation and the Five Phases, possess the same completeness as in a single furnace; knowing the latter allows one to know the former. Therefore, the Qi establishing Heaven is Metal and Fire; the Qi establishing Earth is Earth and Water; the Qi establishing Humanity is Wind and Fire. Thus, when Metal and Fire combine, they produce Heat and Clarity; when Water and Earth combine, they produce Dampness and Cold; when Wind and Fire combine, they produce Warmth and Flare-up.

Similarly, within the human chest and abdomen. The Lung is at the highest position, belonging to Dry Metal, governing Clarity. The Heart follows, belonging to Sovereign Fire, governing Heat. The Liver follows again, belonging to Wind-Wood, governing Warmth. The Gallbladder follows again, belonging to Ministerial Fire, governing Extreme Heat. The Spleen follows again, belonging to Damp-Earth, governing Coolness. The Kidney follows again, located at the Yellow Springs, belonging to Cold-Water, governing Cold. Thus, the Heart and Lung symbolize Heaven, the Spleen and Kidney symbolize Earth, and the Liver and Gallbladder symbolize Humanity. Those who do not understand this cannot be discussed with regarding human diseases.

Earth is the root of all things, Water is the origin of all things. Earth and Water unite in virtue, residing in Yin within Yin, dwelling together below, thereby establishing the Qi of Earth. All things take root in the Earth; therefore, Earth and Water possess Dampness and Cold. If Dryness-Heat and Yang-Repletion were present, the Qi of Earth would not be established, the roots of all things would wither without moisture, and branches and leaves would dry up. The *Wu Chang Zheng Da Lun* (Great Treatise on the Five Constants and Policies) states: "Rooted within is called Shen-Ji (Spirit Mechanism), which pertains to animals, whose root lies within." (This interpretation of the classic is forced and does not reflect its true meaning. The classic originally has two meanings: one refers to animal organs and limbs obeying the center, hence rooted within; plants' branches and leaves originate externally, hence rooted outside. The other refers to human spirit and thought originating in the center, hence rooted within; Ying-Wei Qi and Blood circulate externally, hence rooted outside. If the center fails, there is no consciousness; if the exterior ceases, there is no movement; this does not refer to the Spleen and Kidney. The discussion in the later *Yuan Bing Shi* is extremely correct.)

When food enters the Stomach, the Spleen distributes and transforms its flavors and Qi to nourish the five Zang organs and hundred bones. Thus, Sour flavor enters the Liver and nourishes sinews and fascia; Bitter flavor enters the Heart and nourishes blood vessels; Sweet flavor enters the Spleen and nourishes muscles; Pungent flavor enters the Lung and nourishes skin and hair; Salty flavor enters the Kidney and nourishes bone marrow. The same applies to the five Qi: thus, Clear Qi nourishes the Lung, Heat nourishes the Heart, Warmth nourishes the Liver, Dampness nourishes the Spleen, and Cold nourishes the Kidney. Regarding these five flavors and five Qi, excess causes disease, deficiency also causes disease; only balance brings peace. (From this, it can be seen that the previous emphasis on Damp-Cold and aversion to Dry-Heat was incorrect.) Therefore, the *Liu Jie Zang Xiang Lun* (Treatise on Six Nodes and Viscera Manifestations) states: "Five flavors enter the mouth, store in the intestines and stomach; flavors have their respective destinations to nourish the five Qi. When Qi is harmonious, life arises; fluids and essence form together, and Spirit naturally generates." This is the principle. Furthermore, the *Da Yin Yang Ming Lun* (Treatise on Great Yin-Yang and Bright Yang) asks: "Why does Spleen disease cause the four limbs to be unusable?" Qibo replies: "The four limbs receive Qi from the Stomach, but Stomach Qi cannot reach the meridians directly; it must rely on the Spleen to be received. Now, due to Spleen disease, it cannot transport fluids for the Stomach; the four limbs do not receive water and grain Qi. Qi declines daily, meridians become obstructed, sinews, bones, muscles, and flesh lack Qi to grow, thus becoming unusable." The Emperor asks: "Why does the Spleen not govern a specific season?" Qibo replies: "The Spleen belongs to Earth, governs the Center, and constantly nourishes the four Zang organs during the four seasons, presiding over the last eighteen days of each season, so it cannot exclusively govern one season. The Spleen organ constantly adheres to the essence of Stomach-Earth. Earth generates all things and models itself on Heaven and Earth; thus, from top to bottom to neck and feet, it cannot exclusively govern one season." The Emperor asks: "The Spleen and Stomach are connected only by membranes, yet how can they transport fluids?" Qibo replies: "Foot-Taiyin (Spleen Meridian) is one of the Three Yin meridians; its vessel penetrates the Stomach, belongs to the Spleen, and connects to the throat, so Taiyin transports Qi to the Three Yin. Foot-Yangming (Stomach Meridian) is the Exterior, the Sea of the five Zang and six Fu organs, and also transports Qi to the Three Yang. The Zang and Fu organs each receive Qi from Yangming via their meridians; thus, the Stomach transports fluids for them. Because the four limbs do not receive water and grain Qi, Qi declines daily, meridians become obstructed, sinews, bones, muscles, and flesh lack Qi to grow, thus becoming unusable. 'Unusable' means unable to be utilized. From this, we see that the five Zang and six Fu organs, four limbs, and hundred bones all receive from the Spleen and Stomach, which transport fluids, mutually moistening and nourishing. Later physicians, wishing to use drying-hot agents to nourish the Spleen and Stomach and boost Earth Qi, are not mistaken! Especially for patients with Xiao Ke (Wasting-Thirst), whose fundamental pathology is extreme deficiency of Damp-Cold Yin Qi and excessive abundance of Dry-Heat Yang Qi. Taking more drying-hot medicines would exhaust the Qi of the Spleen and Stomach.

In recent generations, physicians fail to distinguish the deficiency and repletion of the Five Movements and Six Qi, generally stating that Heat is Repletion and Deficiency is Cold. They only understand the deficiency and repletion of the single Qi of Heart-Fire Yang-Heat, not the deficiency and repletion of the Six Qi of the Zang-Fu organs. (The principle of Heat-Repletion and Cold-Deficiency also originates from the *Neijing*, speaking from the perspective of the primordial Qi of human generation, whereas Mr. Li uses the perspective of Five Phase generation and control. Both principles deserve investigation and should not refute each other.) The Lung is fundamentally Clear; when deficient, it becomes Warm. The Heart is fundamentally Hot; when deficient, it becomes Cold. The Liver is fundamentally Warm; when deficient, it becomes Clear. The Spleen is fundamentally Damp; when deficient, it becomes Dry. The Kidney is fundamentally Cold; when deficient, it becomes Hot. For example, if Stomach cold is considered Deficiency, it is because Yin-Water Cold Qi is excessively Replete in the Stomach, while Yang-Fire Hot Qi is deficient, not because the fundamental Dampness of Stomach-Earth is deficient. (This argument is precise, illustrating that each of the Five Phases has both Yin and Yang.) Therefore, one should warm and tonify the decline of Yang-Fire in the Stomach and retreat the excess of Yin-Water Cold Qi. Conversely, if Stomach heat is considered Repletion, it is because Yang-Fire in the Stomach is Replete and Yin-Water is deficient. Thus, one should use cold medicines to drain the Replete Fire in the Stomach and nourish the deficient Water. However, these all address the pathogenic factors caused by deficiency and repletion of water and fire in the Stomach, not the fundamental nature of the Stomach as Damp-Earth. (Identifying the fundamental Qi is Mr. Li's unique secret, based on the Five Phases.)

Regarding the Qi of all Zang and Fu organs, one need not assume Kidney-Water exclusively corresponds to Cold or Heart-Fire exclusively to Heat. One must know that the Qi of every Zang and Fu organ should be harmonized and balanced through dissemination. Thus, I often say: The Way of the Five Phases contains Yin within Yang and Yang within Yin. Solitary Yin does not grow; solitary Yang does not form. Any single entity possesses the Five Phases, mutually supporting and nourishing, which is called Peace. Mutual overcoming leads to Decline and Abundance. Disorder and loss of normalcy bring harm. Therefore, less Water and more Fire constitutes Yang-Repletion and Yin-Deficiency, resulting in Heat disease. More Water and less Fire constitutes Yin-Repletion and Yang-Deficiency, resulting in Cold disease. The treatment method is to drain Repletion and tonify Deficiency, aiming for balance. Thus, treating Xiao Ke involves tonifying the deficiency of Kidney-Water Yin-Cold and draining the excess of Heart-Fire Yang-Heat, removing severe Dry-Heat from the intestines and stomach, and assisting the decline of whole-body fluids. This ensures pathways remain open and unobstructed, fluids generate without withering, and Qi and Blood flow smoothly without stagnation, causing the disease to heal daily. (Resolving nodules, moistening withering, and promoting smooth flow are the subtle truths of treating Xiao Ke and the standard for treating all diseases. The above discusses the fundamental Qi of Zang-Fu and Five Phases, constituting the first section.) Moreover, Xiao Ke arises primarily from improper diet and lifestyle, leading to dry intestines and stomach, preventing the smooth distribution of Qi and fluids. It may result from mental exhaustion and exceeding limits, or from major illnesses damaging Yin Qi and depleting Blood, leaving Yang Qi fierce and Dry-Heat severely constrained. Thus, *Ji Zhong Shu* states: San Xiao (Three Wastes-Thirst) results from long-term craving for salty foods, indulgence in roasted meats, and excessive alcohol consumption. Some young people take mineral pills and powders; accumulated heat settles in the chest, causing lower Jiao deficiency-heat. Blood and Qi cannot restrain the minerals, leading to severe Dry-Heat in the Stomach, causing thirst and excessive drinking.

If drinking water leads to excessive urination, it is named Xiao Ke. If eating large amounts without intense hunger, accompanied by frequent urination and gradual emaciation, it is named Xiao Zhong. If thirst persists despite continuous drinking, with emaciated legs and fatty substances in urine, it is named Shen Xiao (Kidney Waste). These three types of Xiao share the same Dry-Heat nature, differing only in degree. I hear that many prescriptions in the world treat all three types of Xiao Ke with a single formula, because they consume water and grain and cause thirst. However, modern discussions on Xiao Ke often ignore the root cause. They claim Xiao Ke involves Upper Excess-Heat and Lower Deficiency-Cold. Upper Heat causes irritability, thirst, and excessive drinking; Lower Cold causes excessive urination. The root is said to be deficiency of Lower Kidney-Water, failing to control Upper Heart-Fire, resulting in Upper Excess-Heat and Lower Deficiency-Cold. Others state: Water number is one, the root of all things and precursor of Five Phases; thus Kidney-Water is the human root and life's origin, and must not weaken. If the root is not firm, branches will not flourish; if Yuan Qi is not solid, the body will not prosper. In Xiao Ke patients, Lower Kidney-Water is extremely cold. Taking cold medicines further weakens Yuan Qi and depletes Lower Kidney-Water, causing Upper Heart-Fire to flare uncontrollably, making it difficult to treat. Using warm medicines to tonify Yuan Qi, if Lower Kidney-Water becomes solid and overcomes Upper Heart-Fire, thirst will stop, urination will normalize, and the disease will heal. Such statements contradict Zhang Zhongjing, offering clever words that seem plausible but violate logic. This error is not new but has existed for a long time. For instance, Jiang’s *Yao Zheng Bing Yuan* (now lost) discusses Xiao Ke, Xiao Zhong, and Kidney Disease, stating: "San Jiao and Five Zang are all deficiency-heat, only the Bladder is cold as ice"; also: "Lower back and Kidney deficiency-cold increases daily"; also: "Bladder and Kidney are cold as springs." Initially stating San Jiao and Five Zang are deficiency-heat while only the Bladder is cold, then claiming the Kidney is also cold, and describing Kidney coldness as deficiency, while calling other heats deficiency—how can Yin-Yang rise and fall work this way? Their statements are self-contradictory; the error is minor compared to the discrepancy in Cold and Heat, where treatments are largely opposite, a grave mistake. (Mr. Li's refutation is highly logical. However, deficiency-heat and deficiency-cold are often co-existent in patients, not just in Xiao Ke. The *Neijing* also says: "Where Qi combines, Blood is deficient; where Blood combines, Qi is deficient." Is there no Repletion? The answer is: Presence is Repletion, absence is Deficiency. Thus, Qi combining means absence of Blood, Blood combining means absence of Qi; Qi and Blood separating results in Deficiency. Therefore, having both Cold and Heat deficiencies in one body is not entirely illogical. However, medication must draw from Yin to guide Yang, and from Yang to guide Yin, requiring balance. One cannot say Fire deficiency implies Water repletion, or Yin excess implies Yang decline. Later figures like Xue Lizhai argued that Yang excess need not suppress Yang, but rather nourish Yin to match it; Yin excess need not dissipate Yin, but rather assist Yang to match it. This is a biased view, possibly stemming from Mr. Li's theory.) Others argue: Kidney and Bladder belong to Water; deficiency cannot control Fire. Since deficiency cannot control Fire, urination is excessive. This deviates even further. They believe Water Repletion controls Fire, while Water Deficiency cannot. Thus, Yang-Repletion and Yin-Deficiency cause Heat-Dryness of fluids, leading to scanty, dribbling urination; Yin-Repletion and Yang-Deficiency fail to control Water, leading to profuse, frequent urination. Who knows that excessive urination in Xiao Ke is not of this nature? Why? Because Dry-Heat is too severe, causing obstruction and stagnation in the pores of the San Jiao and intestines/stomach. Fluids cannot excrete and infiltrate outward to nourish the body. Outside the intestines and stomach, Dry-Heat is severe. Even with heavy internal drinking, fluids cannot infiltrate outward, so thirst persists. Excessive urination occurs because the ingested water cannot seep out of the intestines and stomach, leading to frequent urination. (This argument is exquisitely precise. Students should penetrate this to understand all diseases. Yet Xu Lingtai and Chen Xiuyuan often criticize Ye Tianshi's meridian-opening theories. Why? The entire *Yuan Bing Shi* only discusses meridian Qi transformation.)

Therefore, I wrote in *Yuan Bing Shi*: The sweat pores of the skin are called apertures for sweating. Also known as Qi Gates, portals for Qi release. Also known as Cili (interstices), tunnels and textures for Qi and fluid passage. Also known as Ghost Doors, gates of darkness. Also known as Xuanfu (Mysterious Factories), mansions of subtlety. Xuanfu exists everywhere: in human Zang-Fu, skin, hair, muscle, sinew, bone marrow, nails, teeth, and even in all things. They are the pathways for entry, exit, ascent, and descent. Thus, the classic states: "If entry and exit cease, Shen-Ji perishes; if ascent and descent stop, Qi-Standing stands alone." Without entry and exit, there is no growth, maturity, aging, and death; without ascent and descent, there is no growth, transformation, harvesting, and storage. Thus, entry and exit exist in every vessel. We know that the functions of eyes, ears, nose, tongue, body, mind, spirit, and consciousness depend on the smooth flow of ascent, descent, entry, and exit. Obstruction prevents function. Blindness, deafness, anosmia, ageusia, sinew flaccidity, bone bi, nail loss, tooth decay, hair loss, skin numbness, and intestinal inability to secrete—all result from Heat Qi constraint, Xuanfu obstruction, preventing Jin-Ye, Blood vessels, Ying-Wei, and Clear Qi from ascending, descending, entering, and exiting. Depending on the severity of the constraint, different diseases arise. Disease in the exterior constrains Cili, sealing Yang Qi, preventing dispersion, causing dryness without sweat, and blocking Qi and fluid exit. Modern physicians do not understand this, wrongly attributing frequent urination in Xiao Ke to Lower Cold, ignoring that intestinal and gastric Dry-Heat constraint causes it. I cite this example.

The world believes Xiao Ke syndrome involves Dry-Heat outside the intestines and stomach, blocking secretion pathways. Although water enters the intestines and stomach, it cannot secrete outward, causing frequent urination and thirst. These few sentences fully explain the principle. Examining all mentions of thirst in the *Neijing* clarifies this. Some attribute thirst to Heart-Lung Qi Jue; some to Liver Bi; some to Spleen Heat; some to Kidney Heat; some to Stomach and Large Intestine Heat binding; some to Intestinal Bi; some to Small Intestine Dan-Heat; some to Malaria; some to rich foods and mineral drugs; some to drunkenness, fullness, and sexual intercourse; some to long travel, fatigue, and great heat; some to Cold damage with dry Stomach; some to febrile disease; some to Wind disease. Although the locations of the five Zang differ and causes vary, they all return to Dry-Heat. (Above elucidates the disease root, the first half of this section. Below cites classics to verify and support the reasoning.)

Regarding Heart-Lung Qi Jue causing thirst, the *Jue Lun* states: "Heart transfers Heat to Lung, transmitting as Ge Xiao (Diaphragm Waste)." Commentary: "Heart Heat enters Lung, transforming over time, creating internal Diaphragm Heat, wasting-thirst with excessive drinking." Regarding Liver Bi causing thirst, the *Bi Lun* states: "Liver Bi involves waking startled at night, excessive drinking, frequent urination." Regarding Spleen Heat causing thirst, the *Wei Lun* states: "Spleen Heat causes dry Stomach and thirst, insensitivity of muscles, developing into Rou Wei (Flesh Flaccidity)." Regarding Kidney Heat causing thirst, the *Ci Re Lun* states: "Kidney Heat disease begins with lower back pain, thigh soreness, bitter thirst, frequent drinking, body heat." The *Re Lun* states: "Shaoyin vessel penetrates Kidney, connects to Lung, ties to tongue base, causing dry mouth and tongue and thirst." Modern physicians only say Kidney deficiency fails to control Heart Fire, causing Upper Excess-Heat and Lower Deficiency-Cold, using hot medicines to warm Kidney Water to overcome Heart Fire. This misunderstands Yin-Yang deficiency and repletion. Kidney Water belongs to Yin and is fundamentally Cold; deficiency leads to Heat. Heart Fire belongs to Yang and is fundamentally Hot; deficiency leads to Cold. If Kidney Water is Yin-deficient, Heart Fire is Yang-replete, meaning Yang-Repletion and Yin-Deficiency, resulting in upper and lower Heat. Clearly, the *Qi Jue Lun* states: "Kidney Qi declines, Yang Qi stands alone." The *Xuan Ming Wu Qi Lun* states: "Kidney detests Dryness; due to Dryness, Kidney withers and Water dries up." The *Zang Qi Fa Shi Lun* states: "Kidney suffers from Dryness; urgently eat Pungent to moisten it." Cold substances belong to Yin, nourishing Water and draining Fire. Hot substances belong to Yang, nourishing Fire and consuming Water. Now, since Kidney Water cannot overcome Heart Fire, resulting in upper and lower Heat, why use hot medicines to nourish Kidney Water to overcome Heart Fire? Is this not absurd? Regarding Stomach and Large Intestine Heat binding causing thirst, the *Yin Yang Bie Lun* states: "One Yang binds, called Xiao." Commentary: "Two Yang bind, Stomach and Large Intestine both have Heat binding. Intestinal and gastric congestion-Heat consumes water and grain well." Also, *Qi Jue Lun* states: "Large Intestine transfers Heat to Stomach, good appetite but emaciation." *Mai Yao Jing Wei Lun* states: "Dan develops into Zhong Xiao (Middle Waste), good appetite but emaciation." Regarding Intestinal Bi causing thirst, *Bi Lun* states: "Drinks frequently but output is blocked, middle breath struggles" (interpreted here as not staying inside but exiting immediately, likely not the original intent), occasional loose stools. If frequent drinking does not stay inside, stool does not linger. Thus, Xiao Ke frequent drinking and urination is merely San Jiao Dry-Heat constraint and Qi decline, clearly. How can one use drying-hot toxic drugs to aid strong Yang and attack weak Yin? This is the crime of truly reinforcing Repletion and falsely depleting Deficiency. Xiao Ke often changes into deafness, blindness, sores, tinea, acne, etc., all due to intestinal and gastric Dry-Heat constraint, preventing fluids from moistening the body. Or severe Heat causes Bladder constraint, preventing secretion, fluids move recklessly, causing facial swelling. Regarding Small Intestine Bi-Heat causing thirst, *Ju Tong Lun* states: "Heat Qi stays in Small Intestine, intestinal pain, Dan-Heat scorches thirst, stool becomes hard and cannot exit." Commentary: "Heat seeps fluids, stool becomes hard." Regarding thirst from Malaria, *Nue Lun* states: "Yang Repletion causes external Heat, Yin Deficiency causes internal Heat. Internal and external Heat cause panting and thirst, desiring cold drinks." However, Yang-Repletion and Yin-Deficiency causing Heat disease requires cold medicines to nourish Yin and drain Heat, the way of draining Repletion and tonifying Deficiency. Regarding thirst from rich foods and mineral drugs, *Qi Bing Lun* asks: "Someone has sweet taste in mouth, what is the disease name?" Qibo replies: "This is overflow of Five Qi, disease named Pi Dan (Spleen Dan)." Dan means Heat. Spleen Heat means four Zang do not receive, so Five Qi overflow upward. (Spleen belongs to Earth, Earth number is five, hence Five Qi, not referring to Five Zang Qi.) Primarily due to Spleen Heat, hence Pi Dan. Also, the classic states: "Five flavors enter mouth, store in Stomach, Spleen transports their essence. Fluids in Spleen cause sweet taste in mouth." This originates from rich foods. Such people must frequently eat sweet and fatty foods. Fatty foods cause internal Heat; sweet foods cause central fullness. Thus Qi overflows upward, turning into Xiao Ke. *Tong Ping Xu Shi Lun* states: "Xiao Dan, Pu Ji, Pian Ku, Wei Jue, Qi Man Fa Ni are diseases of rich and noble people, disorders of Gao Liang (rich food)." Some say: "Humans rely solely on Stomach Qi as root. Spleen and Stomach form Interior-Exterior. Spleen and Stomach, the Central Pivot, should receive warm tonification to regulate diet. Now Xiao Ke patients have extremely deficient Spleen and Stomach, further suitable for warm tonification. If taking cold medicines, they damage Spleen and Stomach, fundamental Qi becomes deficient, making it hard to treat." This statement ignores Yin-Yang, Cold-Heat, Deficiency-Repletion, and Tonification-Drainage principles, speaking recklessly. Does it not know the *Fu Zhong Lun* states: The Emperor asked, Master often says Re-Zhong and Xiao-Zhong cannot take Fang Cao (aromatic herbs) or Shi Yao (mineral drugs). Mineral drugs cause Dian (mania/euphoria); aromatic herbs cause Kuang (rage/insanity). Commentary: "Excessive drinking and frequent urination is called Re-Zhong. Excessive eating and frequent urination is called Xiao-Zhong. Excessive joy is Dian. Excessive anger is Kuang. Fang means delicious. Shi refers to Ying and Ru, heating drugs." The classic further states: "Re-Zhong and Xiao-Zhong are diseases of the wealthy and noble. Now prohibiting rich foods..."