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A guest suffered from Shanghan (Cold Damage). He presented with diarrhea, fever, mental confusion with fatigue, delirious speech, and insomnia. Some observers, seeing the diarrhea and attributing the delirium to Zhengsheng (a sign of deficiency characterized by low, indistinct speech), concluded that it was a Yin deficiency syndrome. I examined his pulse and stated that this was a Chengqi Tang syndrome. The crowd was astonished, asking, "Is administering Chengqi Tang for diarrhea in accordance with Zhang Zhongjing's method?" I replied, "Zhang Zhongjing stated: 'In cases of diarrhea accompanied by delirium, there is dry feces retained in the intestines. This belongs to the Xiao Chengqi Tang syndrome.'" Consequently, I administered Xiao Chengqi Tang (Minor Order the Qi Decoction). After defecation, the diarrhea ceased, and twelve pieces of dry, hard feces were passed. Shortly thereafter, he perspired and recovered.

The commentary states: The *Neijing* (Inner Canon) says, "For mild conditions, use contrary treatment; for severe conditions, use following treatment." Contrary treatment is standard treatment; following treatment is paradoxical treatment. One must observe the circumstances to determine whether to follow or oppose. The Yellow Emperor asked, "What is meant by paradoxical treatment?" Qibo answered, "Use cold to treat cold [symptoms]; use unblocking to treat unblocking [symptoms]." Wang Bing interpreted this as: When intense heat is internally bound, causing incessant diarrhea, heat should be treated with cold herbs, and the trapped heat must be eliminated. By using cold purgatives, the binding disperses and the diarrhea stops. This is "using cold to treat cold." Xiao Chengqi Tang stopping the diarrhea perfectly aligns with this principle.

In the year Bingwu, the merchant Zhang Hao fell ill at the end of summer. He had excessive sweating on the chest and neck, coldness in the four limbs, headache, and delirium. I examined his pulse: the position before the cun (guan anterior) was Ru (Soggy), and the position after the cun (guan posterior) was Shu (Rapid). I diagnosed it as Wet-Warmth disease to be treated accordingly. This occurred because he first contracted Summerheat, then Dampness. The struggle between Summerheat and Dampness is termed Wet-Warmth. I administered Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), followed by Baihu Cangzhu Tang (White Tiger Decoction plus Atractylodes Rhizome). His headache gradually subsided, his feet warmed, and sweating stopped. He recovered after several days. This disease is named Zei Xie (Robber Pathogen); if misdiagnosed and mistreated, it leads to death.

The commentary states: Someone challenged, saying, "What is Zei Xie?" I replied, "The *Nanjing* (Classic of Difficult Issues) discusses five types of pathogens: Shi Xie (Excess Pathogen), Xu Xie (Deficiency Pathogen), Zheng Xie (Direct Pathogen), Wei Xie (Mild Pathogen), and Zei Xie (Robber Pathogen). Coming from what follows is Xu Xie; coming from what precedes is Shi Xie; coming from what one cannot overcome is Zei Xie; coming from what one can overcome is Wei Xie; originating from one's own organ is Zheng Xie. Furthermore, if Heart disease results from Summerheat, it is Zheng Xie; if it results from Dampness, it is Zei Xie. Now, the Heart is first affected by pathogenic factors, and Dampness prevails. Water overcomes Fire, coming from what cannot be overcome; thus, it is Zei Xie. It is the most adverse among the five pathogens. The *Nanjing* states: In Wet-Warmth, the Yang pulse is Ru and weak, and the Yin pulse is small and rapid. Ru and weak appearing in the Yang portion indicates Dampness struggling with Summerheat; small and rapid appearing in the Yin portion indicates Summerheat steaming Dampness. Therefore, the classics say: Summerheat and Dampness struggling together are named Wet-Warmth. This is Zei Xie."