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Year of Gui-Si and Gui-Hai
Wang Bing stated: These belong to the category of "Tong Sui Hui" (Same Year Meeting).
The transformation at the upper level should utilize acrid-cool substances; at the middle level, salty harmonizing substances; and at the lower level, salty-cold medicinal and dietary substances. These are appropriate.
Zhang Jiebin stated: The Central Movement (Da Yun) is Shao Zheng (Deficient Fire), receiving generation and assistance from Heaven and Earth Qi, thus it is appropriate to use salty flavor to harmonize; the Upper (Si Tian) and Lower (Zai Quan) levels are identical. Ji's commentary: According to *Yuan Zhu Mi Yu*, regarding the celestial movement superimposition chronology, in the year of Gui-Hai, wind disease prevails above; treatment utilizes acrid-cool medicines, employing the nature and flavor of Metal to subdue the excess of Wind-Wood. One should not consume sour foods to assist the Wood excess. In *He Yuan Ji Yong Jing*, the discussions for the upper, middle, and lower sections are all consistent.

The Yellow Emperor asked: Medical theories state "Do not offend heat with heat, do not offend cold with cold." I wish to neither stay far from cold medicines nor stay far from hot medicines. How should this be handled?
Qi Bo replied: Your question is thorough! For releasing the exterior (Jie Biao Fa Han), one does not stay far from hot medicines; for attacking the interior (Gong Li Xie Xia), one does not stay far from cold medicines.
Wang Bing explained: Because sweating is required to vent pathogens, hot medicines are used without staying far from heat; because purgation is required for diarrhea/constipation, cold medicines are used without staying far from cold. This is because these medicines do not remain stagnant within the body. If this were the case, hot medicines could be used in summer and cold medicines in winter; as long as there is no sweating or purging, there would be no taboos. This is called recklessly ignoring the methodological prohibitions, which is forbidden by therapeutic laws. It is stated that these are only used when unavoidable. The same applies to autumn and winter. The New Correction notes: According to *Zhi Zhen Yao Da Lun*, releasing the exterior does not stay far from heat, and attacking the interior does not stay far from cold. In winter, attacking the interior does not stay far from cold. Exterior-releasing and interior-attacking medicines do not remain in the middle but have specific appropriateness. Ma Shi stated: This passage refers to sweating and purging methods; pathogens can occasionally be confronted with heat or cold, but one should not offend them without cause. This statement is incorrect. When pathogens are constrained in the exterior, hot medicines are used to disperse them; when heat accumulates in the interior, cold medicines are used to attack them. Zhang Jiebin stated: Pathogens in the exterior are mostly cold pathogens, so exterior-releasing treatments cannot stay far from heat, even in summer. Pathogens constrained in the interior are mostly heat pathogens, so interior-attacking treatments cannot stay far from cold, even in winter. My analysis: The main idea of these two sentences lies entirely in the characters "Fa" (Disperse/Release) and "Gong" (Attack/Purge). "Fa" means driving pathogens outward; "Gong" means driving pathogens inward. Cold pathogens in the exterior cannot be dispersed without warm-hot qi; therefore, those releasing the exterior do not stay far from heat. Heat constrained in the interior cannot be eliminated without heavy-cold substances; therefore, those attacking the interior do not stay far from cold. This is an inevitable principle. However, there are cases where Xiao Chai Hu Tang (Minor Bupleurum Decoction), Bai Hu Tang (White Tiger Decoction), Yi Yuan San, or cold water are used to induce sweating and cure disease. Why? This is because both exterior and interior are hot, so cool resolution is indicated; this is not "releasing" in the sense of dispersing cold. There are also cases where Li Zhong Tang (Regulate the Middle Decoction) and Si Ni Tang (Frigid Extremities Decoction) for restoring Yang are used to eliminate pain and remove accumulation. Why? This is because yin-cold is stagnating, so warming the middle is indicated; this is not "attacking" in the sense of purging excess. "Fa" refers to opening the external constriction; "Gong" refers to destroying internal excess. Modern ignorant practitioners, seeing only external contraction fever, fail to perceive that injury by cold transforms into heat, possessing the meaning of original cold and manifest heat. They arbitrarily use Huang Qin (Scutellariae Radix) and Lian Zi (Nelumbinis Semen) to clear superficial heat. Do they not know that cold pathogens are in the exterior while cold medicines act in the interior? Using cold to attract cold qi creates resonance, leading to combined exterior-interior pathogens, making them incurable. This is the harm of using cold medicines for exterior release. During the spring, autumn, and winter seasons, and during periods governed by Earth, Metal, and Water where yin prevails and yang is weak, this is especially contraindicated. Fire not being in the interior makes cold-cool substances most taboo; misusing them here shows ignorance that exterior release requires not staying far from heat. Similarly, for internal injuries causing panting, pain, and distension, often involving deficiency of the Three Yin, modern practitioners see such conditions, fail to distinguish deficiency-cold, and use Xiao (Nitratum) and Huang Bo (Phellodendri Cortex) or similar purgatives, claiming to first remove pathogens then tonify the root. This seems plausible, but do they not know diseases of false excess and true deficiency? Further attacking such conditions leaves the pathogen unremoved while vital Qi collapses. Misusing this method shows ignorance that interior attacking requires not staying far from cold. I have seen these two harms frequently and must highlight them as a warning to practitioners. Ji's commentary: *He Yuan Ji Yong Jing* discusses how the five flavors' cold, hot, warm, cool, and neutral natures coordinate with the Five Zang organs, linking to Five Elements, entering Five Qi, and having Five Appropriatenesses. Usage varies according to the excess or deficiency of annual movements. The six Qi's root and branch are the pivot of treatment. Medicines for the six Qi involve cold, heat, dryness, dampness, wind, and fire. The overcoming Qi and Intermediate Seeing Qi determine usage. Five Movements may be contrary or follow Heaven, opposing Earth, or follow Earth, opposing Heaven. The transformations of imperial control involve the expansion and contraction of Yin and Yang. Human affairs can be regulated. Use cold avoiding cold; do not offend cold with cold. Use heat avoiding heat; do not offend heat with heat. Following nourishes harmony; opposing causes illness.

The Yellow Emperor asked: What happens if one offends heat and cold without releasing the exterior or attacking the interior?
Qi Bo replied: If heat and cold become internal thieves, the disease will worsen.
Wang Bing explained: Adding water to water and fire to fire only serves to generate more illness, let alone worsening the original disease. Ma Shi stated: If one offends heat without releasing the exterior, heat becomes an internal thief and intensifies; if one offends cold without attacking the interior, cold becomes an internal thief and prevails. Ji's commentary: *He Yuan Ji Yong Jing* states that Wood stands in relation to the five Qi of the four seasons, affecting diet, clothing, and medicine warmth. Thus, lightly offending heat and cold implies avoiding similarities. If the four seasons are commonly offended, adding water to water and fire to fire will inevitably cause disease. Qi Bo stated: When the controlling Qi is heat, use heat without offending the intercalary Qi. If the intercalary Qi matches the principal Qi, do not offend it; if it differs, a slight offense is permissible. This is called the "Four Feared Things," requiring careful observation. When heavenly weather is contrary to the season, one may adjust according to the time; if contrary phenomena are severe, they cause disease. If the controlling Qi is overcome, it may be offended. For example, if cold is severe in summer, heat may be used; if cold is not severe, it should not be offended. The goal is balance; exceeding it causes disease, similar to counter-offending. When pathogens overcome the principal Qi, they cannot be resisted. *Yao Ge* states: Severe cold repelling Yang (Ge Yang) treats heat with heat; never use cold to treat Ge Yang. Severe heat rejecting Yin (Ju Yin) treats cold with cold; never use heat to treat Ju Yin. Externally appearing compliant but internally reversing Qi. Due to differing Qi forms causing confusion of the Classics, caution is essential.

The Yellow Emperor asked: I wish to hear about those without disease.
Qi Bo replied: Those without disease who violate taboos will get sick; those with disease who violate taboos will suffer exacerbation.
Wang Bing explained: Even those without disease who violate taboos can fall ill; how much harder is it for those with disease to seek relief through violation? Wu Kun stated: Without disease, offending heat and cold generates cold and heat illnesses; with disease, offending heat and cold makes cold and heat more severe. Ma Shi stated: Those without disease who mistakenly take medicines only suffice to cause illness, let alone those with disease whose condition worsens.

The Yellow Emperor asked: How does illness arise?
Qi Bo replied: Not staying far from heat leads to heat arrival; not staying far from cold leads to cold arrival. Cold arrival causes hardness, obstruction, abdominal fullness, painful urgency, and diarrhea.
Wang Bing explained: Eating without hunger, vomiting and diarrhea with foul odors, are also cold diseases. Ma Shi stated: Offending cold leads to cold arrival, causing diseases such as hardness, obstruction, abdominal fullness, painful urgency, and diarrhea. Zhang Jiebin stated: Cold arrival causes Yang decline, inability to transport and transform, depression, downward flow, twitching eyelids, convulsions, edema, foot swelling, vomiting, nasal congestion, epistaxis, headache, bone joint deformation, internal pain, blood extravasation, bloody stool, and strangury.
Wang Bing explained: Sudden aphonia, dizziness, blindness, restlessness, mania, delusions, hallucinations, cursing, fright, and epilepsy are also heat diseases. Ma Shi stated: Offending heat leads to heat arrival, causing diseases such as body heat, vomiting and diarrhea, cholera-like syndrome, carbuncles, sores, mental clouding, depression, downward flow, convulsions, swelling, vomiting, nasal congestion, epistaxis, headache, bone joint deformation, internal pain, blood extravasation, bloody stool, and strangury. Zhang Jiebin stated: Heat arrival causes fire to scorch the meridians.

The Yellow Emperor asked: How to treat them?
Qi Bo replied: One must conform to the season; offenders are treated with what overcomes them.
Wang Bing explained: Spring suits coolness, summer suits cold, autumn suits warmth, winter suits heat. This seasonal appropriateness must not be disobeyed. However, if heat is offended, treat with cold; if cold is offended, treat with heat. If spring is offended, use cool; if autumn is offended, use warm. This is treating with overcoming. If heat is offended, treat with salty-cool; if cold is offended, treat with sweet-hot; if cool is offended, treat with bitter-warm; if warm is offended, treat with acrid-cool. This is also the way of overcoming. Wu Kun explained: Conforming to the season means following its ascending, descending, floating, and sinking. Treating offenders with what overcomes them means opposing their cold, heat, warmth, and coolness. Thus, spring suits ascending, autumn suits descending, summer suits floating, winter suits sinking—this is conforming to the four seasons. Warm suits cool, heat suits cold, cool suits warm, cold suits heat—treating with what overcomes is called treating by superiority. Zhang Zhicong stated: This refers to the Six Qi governing the season, which should also avoid cold and heat. The previous chapter's "Do not offend heat with heat, do not offend cold with cold" discussed Si Tian and Zai Quan plus superimposed Six Qi. This chapter discusses the Six Qi governing the season, which also has distinctions of cold and heat. Tai Yin Qi is in late summer, Tai Yang Qi in winter, Shao Yin Qi in summer, Yang Ming Qi in autumn, Jue Yin Qi in spring. If winter has heat transformation, it indicates Shao Yin excess; if summer has cold transformation, it indicates Tai Yang excess. This is consistent with the meaning of Spring overcoming Late Summer and Late Summer overcoming Winter. Xu Zhengong stated: This is exactly what the Emperor asked about: victory and retaliation. In Six Qi, it is victory and retaliation; in Four Seasons, it is victory and transformation. Ma Shi stated: Treatment: Spring suits cool, summer suits cold, autumn suits warm, winter suits heat. This is necessary for the season and must not be disobeyed. If there is an offense and disease dominance occurs, then: offend heat with salty-cold, offend cold with sweet-hot, offend cool with bitter-warm, offend warm with acrid-cool. Treat with what overcomes, and the disease can be resolved. Zhang Jiebin stated: Conform to the season; treatment should accord with the season. If mistakenly offended, treat with what overcomes. Ji's commentary: *He Yuan Ji Yong Jing* states Six Qi are primary, Five Flavors are functional. Prepare medicines according to the year to avoid omission. Main drugs correspond to the year, flavors correspond to Qi. Density and thinness of Qi and flavor, active and static nature, treatment preservation quantity, power and transformation depth, cold, heat, warmth, and coolness are used according to what overcomes. Annual movement governance involves suppression and support systems, overcoming victory and supporting weakness. Guest and Principal must be peaceful. If one Qi loses its place, contradictions arise. Zang-Fu excess leads to danger and collapse. Precious books discuss medication preparation. Medicines lacking complete Five Flavors and Four Qi, taken long-term, may initially win benefits but eventually lead to premature death due to changes. Cold, heat, warmth, and coolness are diminished by their attributes, benefiting wherever applicable. Ten thousand attempts, ten thousand completions. Expansion and contraction depend on the mind; departure and retention follow intent. Minor cases oppose them; major cases follow them. Dragon fire flares with moisture and burns upon water. Subdue the principal, address the cause. Sage like Nanyang [Zhang Zhongjing], unique in past and present. Qi movement medicine usage follows the above examples. I believe that during great heat, one may obtain cold syndromes; during great cold, one may obtain heat syndromes. Syndromes have tendencies. Yin deficiency, even in deep winter, with depleted Yin essence, Water fails to control Fire, Yin has no basis, escapes outward as heat, or manifests as sweating. Medicine should nourish Yin. If abandoning syndrome for season, mistakenly using acrid-warm, death will be immediate. Also, Yang deficiency, even in midsummer, with insufficient Yang failing to protect the exterior, shivering and trembling, desiring hot food, wearing heavy furs, heavenly heat cannot counteract true Yang deficiency. Disease belongs to deficiency-cold; medicine should warm and tonify. If following season abandoning syndrome, mistakenly using bitter-cold, death will be immediate. Furthermore, Spring governs ascending. Ascending is Spring Qi, Wind transformation, Wood image. Ascending has the meaning of dispersing. If due to diet and fatigue, Yang Qi sinks, one should ascend Yang and benefit Qi; if diarrhea persists, ascend Yang and benefit Stomach; if depressed fire hides inside, ascend Yang and scatter fire; if dampness causes profuse diarrhea, ascend Yang and remove dampness. These conditions occur in all four seasons, especially summer and autumn. The command to ascend is not exclusive to Spring. Autumn governs descending. Descending is Autumn Qi, Dryness transformation, Metal image. Descending has the meaning of gathering. If Yin fire flares upward, causing cough with phlegm, hematemesis, epistaxis, bitter taste, dry tongue, headache, toothache, bone-steaming fever and chills, this is Upper Heat and Lower Deficiency syndrome. One should use Pi Pa Ye (Loquat Leaf), Mai Dong (Ophiopogonis Radix), Bei Mu (Fritillariae Bulbus), Bai Shao (Paeoniae Radix Alba), Niu Xi (Achyranthis Bidentatae Radix), Wu Wei Zi (Schisandrae Fructus) to descend Qi, or use Kidney-Nourishing and Essence-Replenishing medicines to save the root. This also occurs in all four seasons, common in summer and winter. The command to descend is not exclusive to Autumn. Qi movement medicine usage must be viewed flexibly.