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For deficiency syndromes, apply tonification; for excess syndromes, apply purgation. Even a child of three years old knows this. But what about the Five Excess (Wu Shi) and Five Deficiency (Wu Xu) syndromes? How can one casually prescribe medication based on general concepts of excess and deficiency? The *Huangdi Neijing* (Yellow Emperor's Inner Canon) clearly describes their manifestations, yet ordinary physicians fail to recognize them. This is why patients often die at the hands of incompetent doctors who are lethargic and inept. Watching others die while boasting, "My medication is stable," thereby deceiving the patient's family, is common. Scholars throughout the world also genuinely believe this, thereby deceiving future generations. Is this not strange?

The human body is like a state. For instance, when Wang Xun led a million troops to besiege Kunyang, this represented an **Five Excess** syndrome; thus, Prince Xiao (Liu Xiu) personally ventured into the central plains to fight a decisive battle. Conversely, when Henei suffered famine compounded by fire, this represented a **Five Deficiency** syndrome; thus, Ji An disregarded the risk of forging imperial edicts to open granaries for relief. Such principles of adapting to changing circumstances can only be discussed with those who understand flexibility, not with those who cling to convention and trivialities.

Therefore, it is said: Mediocre people mislead the world, and mediocre physicians mislead patients; the principle is the same.

The *Huangdi Neijing* states: Those presenting with Five Excess will die; those presenting with Five Deficiency will also die. "Five Excess" refers to all five Zang organs being in an excess state; "Five Deficiency" refers to all five Zang organs being in a deficiency state. Fu organ diseases belong to Yang, are easier to treat, and rarely result in death; Zang organ diseases belong to Yin, are difficult to treat, and frequently result in death.

The Classic explicitly states: A surging pulse, hot skin, abdominal distension, obstruction of urination and defecation, and chest oppression with dizziness constitute the Five Excess syndrome. A surging pulse corresponds to the Heart; hot skin corresponds to the Lung; abdominal distension corresponds to the Spleen; obstruction of urination and defecation corresponds to the Kidney; chest oppression and dizziness correspond to the Liver. These are signs that all five Zang organs are in excess. The Five Deficiency syndrome is the opposite: a fine pulse, cold skin, shortness of breath, uncontrolled diarrhea and urinary incontinence, and inability to eat or drink. A fine pulse corresponds to the Heart; cold skin corresponds to the Lung; shortness of breath corresponds to the Liver; uncontrolled diarrhea and urinary incontinence correspond to the Kidney; inability to eat corresponds to the Spleen. These are signs that all five Zang organs are deficient.

Five Excess means the five Zang organs are excessively hyperactive; Five Deficiency means they are profoundly inadequate. When the *Neijing* says these two syndromes lead to death, it does not mean death is inevitable, but rather that without treatment, death occurs, and even with treatment, improper methods also lead to death. The text further states: "If porridge enters the stomach, the deficient patient lives; if sweat appears and bowels move, the excess patient lives." These two statements are actually therapeutic methods for the aforementioned syndromes. Later generations misunderstood these as diagnostic criteria for life and death, believing that presence of these signs indicates survival and absence indicates death. Allowing a deficient patient to wait for porridge to enter the stomach naturally, and allowing an excess patient to wait for spontaneous sweating and bowel movements, is equivalent to sending them to their death. Is this not absurd?

If porridge enters the stomach without causing diarrhea, the Stomach Qi harmonizes. When Stomach Qi harmonizes, the Five Deficiency transforms into excess, leading to survival. Sweating resolves the exterior, and purgation resolves the interior. Simultaneous resolution allows communication between the upper and lower jiao. When upper and lower communicate, the Five Excess is opened, leading to survival. These two syndromes are exceptional and severe; routine medications are inappropriate. The statement by Ban Gu regarding "not taking medicine when ill" applies because the disease is major and critical.

In my past military service along the Jianghuai region, a boatman fell ill. Upon diagnosis, I identified it as a Five Excess syndrome. Having studied medical classics since childhood, I recalled the description of this syndrome but had never encountered it clinically. Observing the patient, I privately deduced that conventional therapy would fail; instead, a large dose of purgatives was required. Initial treatments failed to move the condition. Exhausted of ideas, I suddenly remembered Taohua E Wan (Peach Blossom Calyx Pill). I administered 70–80 pills immediately. The patient experienced over 200 episodes of diarrhea, expelling both the new and previous medications. He fell into a coma-like stupor, recovering after several days. This was necessary because removing a major pathogen requires natural rest; otherwise, the pathogenic qi cannot subside. Subsequently, I used herbs to harmonize Stomach Qi, gradually increasing his intake of rice gruel, and he recovered.

Once passing through the Mingu Post Station, I heard groaning from someone who was emaciated, flaccid, and weak. Upon examination, I diagnosed a Five Deficiency syndrome. I urgently prescribed Sheng San Zi (Holy Powder), combining two doses into one preparation. This syndrome cannot be treated with small doses of 3 qian or 2 qian. I then followed up with Wei Feng Tang (Stomach Wind Decoction) and Wu Ling San (Five-Ingredient Powder with Poria), administering large doses at once. Diarrhea ceased, porridge entered the stomach, and within a few days, the patient rose and recovered.

Therefore, for Five Deficiency syndromes, unless strong astringent and tonifying measures are taken, recovery is impossible. Mediocre physicians treat these syndromes with casual tonification or purgation, akin to using a cup of water to extinguish a cartload of burning firewood. They achieve no success yet claim, "Deficiency cannot be tonified, excess cannot be purged." What nonsense! It is the fault of incompetent physicians who do not understand excess and deficiency that they force tonification on non-deficient cases and force purgation on non-excess cases. How can there be a principle that deficiency cannot be tonified or excess cannot be purged?

I later reflected: For Five Excess syndromes, employing sweating, purgation, and vomiting methods simultaneously yields faster results; for Five Deficiency syndromes, simple tonification suffices! Yet today, some physicians still obstruct treatment for Five Excess, and for Five Deficiency, they use incorrect tonifying herbs. Patients who should survive instead suffer from sluggishness and delay, ultimately dying. Sheng San Zi contains Gan Jiang (Dried Ginger), typically used for diarrhea, addressing specific indications. Wei Feng Tang and Wu Ling San contain Gui Zhi (Cinnamon Twig), which warms meridians, disperses the exterior, and separates fluids. Sheng San Zi’s astringency and dryness, and the fluid-separating ability of Wei Feng Tang and Wu Ling San, are all acrid-hot or acrid-warm formulas. Vulgar physicians often gather to slander me, claiming I favor cold-cooling herbs. Do I not use warm-tonifying herbs? I simply do not encounter suitable cases for them.

Slander abounds; everyone seeks to boast and gain fame. Who shall judge this? Alas!