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There is one phrase that can summarize the essence of medicine, which is likely "releasing the exterior" (Fa Biao) and "attacking the interior" (Gong Li). Although medical theories branch out into thousands of streams, they are merely distinguished by whether the pathology is in the exterior or the interior. To attack the interior, cold-natured medicines should be primarily used; to release the exterior, hot-natured medicines should be primarily used. This principle remains unchangeable for ten thousand generations. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) has elaborated on this in detail! Nowadays, many people misunderstand its essence, so I am re-annotating it here. "Releasing the exterior does not avoid heat; attacking the interior does not avoid cold." These two characters, "cold" and "heat," refer to the cold and heat attributes of the dominant Qi (Si Qi) among the Six Qi (Liu Qi). When the dominant Qi is cold, physicians should not use cold medicines; when the dominant Qi is hot, physicians should not use hot medicines. This is the general rule. However, regarding attacking the interior and releasing the exterior, the approach is reversed.

Nevertheless, attacking the interior and releasing the exterior are usually treated as two separate paths. If the disease is in the exterior, even during times when the sun is hot enough to melt metal and stone, one should not shy away from the heat of the dominant Qi, but must still use hot medicines to release the exterior. If the disease is in the interior, even during times of hard ice and accumulated snow, one should not shy away from the cold of the dominant Qi, but must still use cold medicines to attack the interior. What is meant by "releasing the exterior" is inducing sweating; what is meant by "attacking the interior" is inducing vomiting or purging. Wang Taipu (Wang Bing) annotated: Sweating, purging, and dysentery all occur because the medicine does not stay in the middle. Since the medicine does not stay in the middle, it passes through without lingering. Therefore, even if cold medicines are used to confront the cold of the dominant Qi, or hot medicines are used to confront the heat of the dominant Qi, there will be no harm. However, if the medicine lingers and does not exit, it will only add to the pathogenic influence of the dominant Qi. This is called neither releasing nor attacking. If cold and heat become internal thieves, the disease will worsen. Those without disease will fall ill, and those with disease will suffer severely. If, during a time when the dominant Qi is cold, the disease is in the exterior and not the interior, but cold medicines are used to freeze the interior, and without vomiting or purging, it will lead to abdominal hardness, fullness, pain, and urgency, causing dysentery. Conversely, if, during a time when the dominant Qi is hot, the disease is in the interior and not the exterior, but hot medicines are used to dry the interior, and without inducing sweating, it will cause fever, vomiting, diarrhea, cholera, carbuncles and sores, itching ulcers, mental confusion and depression, sudden profuse diarrhea, convulsions, swelling, vomiting, nasal congestion and epistaxis, headache, joint stiffness, muscle pain, bloody stool, stranguria, and urinary retention. From this, we know that without heat, the exterior cannot be resolved; without cold, the interior cannot be attacked. Thus, resolving the exterior usually requires hot medicines, and attacking the interior usually requires cold medicines. To reverse this method is considered reckless fabrication.

Today's physicians use Jinghuang Tang (Bramble and Rhubarb Decoction) to release the exterior and Jianggui medicines (Ginger and Cinnamon preparations) to attack the interior. How is this different from using water to save water or fire to save fire? Consequently, not only is it ineffective, but mild cases may become critical, and severe cases may result in death. The *Bencao* (Materia Medica) book contains only six flavors: sour, bitter, sweet, pungent, salty, and bland. The Sages established that pungent and sweet flavors disperse and belong to Yang; sour and bitter flavors induce vomiting and purging and belong to Yin; and bland flavors promote drainage and belong to Yang. Therefore, the three flavors of pungent, sweet, and bland are used to release the exterior, while the three flavors of sour, bitter, and salty are used to attack the interior. Releasing the exterior and promoting drainage—what else is this but releasing the exterior? Inducing vomiting and purging—what else is this but attacking the interior? These two principles encompass the methods of the Sages completely; nothing can surpass them.

So, are the methods of medicine truly numerous? They are merely attacking the interior with cold and releasing the exterior with heat. Nevertheless, if the disease is in the exterior but not the interior, one can exclusively use hot medicines to release the exterior; if the disease is in the interior but not the exterior, one can exclusively use cold medicines to attack the interior. If both the exterior and interior are diseased, although one can use hot medicines to release the exterior, one can also use cold medicines to attack the interior. Zhang Zhongjing's Da Chaihu Tang (Major Bupleurum Decoction) and Xiao Chaihu Tang (Minor Bupleurum Decoction), while releasing the exterior, also concurrently attack the interior, which is most appropriate. Today's physicians only know how to use hot medicines to release the exterior and do not examine whether the interior is already diseased. Therefore, the heat syndromes mentioned earlier all arise. Physicians do not realize that the fault lies with themselves; instead, they falsely claim that these are transformed syndromes of Shanghan (Cold Damage), thereby blaming the patients. This has not been an isolated incident. Therefore, Liu Hejian independently formulated Tongsheng San (Universal Rescue Powder) added with Yiyuan San (Benefit Origin Powder), named Shuangjie (Double Resolution). Among all ages since antiquity, Liu Hejian is the only one who understood the essence of Zhang Zhongjing. However, contemporary critics argue that Shuangjie should not be used for attacking the interior, leading to widespread slander and discussion. Sitting in a well and viewing a small sky, this is indeed regrettable! How could they know that Shuangjie decocted with green onion roots and fermented soybeans, inducing vomiting and sweating, can immediately relieve the patient's suffering with just one dose. Even if not fully cured, it can provide slight relief. The previously mentioned heat syndromes will not recur. After the transmission through the Six Channels (Liu Jing) is complete, mild purging suffices. Today's physicians do not understand its infinite merit in benefiting beings, but instead recklessly slander it as infinitely damaging to the stomach. Out of jealousy for Liu Hejian's reputation as a skilled physician, they set up sophistical arguments to seek worldly praise. Who would dare to test the uncut jade and then regret the fate of Bian He having his foot cut off?

The reason I have written this repeatedly is to sigh at the difficulty of meeting true connoisseurs. Recently, an old friend of mine, an official whose name I will not disclose due to illness, suffered from stiffness in the head and neck, resembling Shanghan. He took Tongsheng San. Although he did not follow the correct method, it caused no harm. A physician saw that he had taken Tongsheng San and immediately condemned it as not being a prescription from Zhang Zhongjing. The physician failed to observe that the heat was already severe and again administered pungent-hot medicines to disperse. After sweating, the disease did not resolve, and jaundice and bloody stool appeared, exactly as described earlier. Later, although Chengqi Tang (Chengqi Decoction) was used to purge, it could not cure him. Purging was repeated until sweat became continuous (Jue Han), yet the pulse remained forceful. I personally witnessed his son describe this in detail. To this day, the scholar-officials do not recognize the error of excessive pungent-hot dispersion, but solely blame Tongsheng San. Alas! It is too difficult to clarify the Dao!

Recently, my old acquaintance read Ban Gu's *Han Shu: Yi Wen Zhi* (Book of Han: Treatise on Literature), which records the concept of "Five Bitters and Six Pungents" (Wu Ku Liu Xin), but Yan Shigu and others provided no annotations. He specifically asked me about it. I reviewed the various books of the *Neijing* but did not find this text. After we parted, while riding my donkey more than ten li away, I suddenly realized the meaning. I wanted to return to tell my old acquaintance, but he had already returned and was far away. So I instructed him to record it to show future generations. The "Five" refers to the Five Zang Organs (Zang); the "Six" refers to the Six Fu Organs (Fu). The Fu organs correspond to the exterior. Diseases in the interior belong to the Yin division and are suitable for treatment with bitter-cold medicines to induce vomiting or purging. Diseases in the exterior belong to the Yang division and are suitable for treatment with pungent-warm medicines to disperse or induce sweating. This is the meaning of "Five Bitters and Six Pungents." Yan Shigu did not annotate it, likely leaving it as a doubt. Thus, we know that attempting to practice medicine without broad learning is extremely difficult! I further pondered: Wu Ji (Five Accumulations) and Liu Ju (Six Gatherings) also follow this principle. Wu Ji are located in the Zang organs, have fixed forms, and belong to the interior; they are suitable for treatment with bitter-cold medicines to induce vomiting or purging. Liu Ju are located in the Fu organs, have no fixed forms, and belong to the exterior; they are suitable for treatment with pungent-warm medicines to disperse or induce sweating. This also aligns with the previous concept of "Five Bitters and Six Pungents." There are also cases of exterior heat where cool Chaihu (Bupleurum) can be used, yet it is still advisable to guide it with warm properties. There are cases of interior cold where hot Ginger (Shengjiang) and Aconite (Fuzi) can be used, yet it is still advisable to guide them with cold properties. Fearing that future generations will not understand the essence of releasing the exterior and attacking the interior from the *Neijing*, I have appended the theory of "Five Bitters and Six Pungents" from Ban Gu to this volume.