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[Background Information]
Book: Neijing Yao Yue (Clarifications on Medicines in the Inner Canon)
Author: Zhang Ji (Zhang Ji)
Dynasty: Qing Dynasty
Chapter: Medicine Preparation (Part 2/3)
Category: Materia Medica

[English Translation]

Belonging to Fire, Fire generates Earth. Earth prefers warmth and abhors cold; therefore, warm agents should be used to assist it. In years of Yi and Geng, Wu is the head transport. Wu belongs to Earth, and Earth generates Metal. Metal prefers clarity and abhors dryness; thus, neutral agents should be used to clear it. In years of Bing and Xin, calculation starts from Geng. Geng belongs to Metal, and Metal generates Water. Water prefers warmth; if cold, it congeals. Therefore, hot agents should be used to warm it. In years of Ding and Ren, Ren flows forward smoothly. Flowing down from Ren is Gui. Gui belongs to Water, and Water generates Wood. Wood is inherently cold and fears dryness; hence, harmonizing agents should be used to balance it. In years of Wu and Gui, where does Jia initiate? It is best sought at Jia-Yin. Jia belongs to Wood, and Wood generates Fire. Fire’s nature is originally hot but abhors excessive heat; thus, cooling agents should be used to resolve it. Furthermore, reference should be made to the Si Tian (Heavenly Sovereign Qi governing the first half of the year) and Zai Quan (Earthly Sovereign Qi governing the second half of the year). Aligning with Heaven is called "Tian Fu" (Heavenly符); receiving the annual transport is called "Sui Zhi"; and various methods such as the Three Harmonies are applied. The deduction of Wu Yun Liu Qi (Five Movements and Six Qi) leaves no omissions. Additionally, among the Five Movements, Jia-Ji Earth Transport is supreme; among the Six Qi, Shao Yin Jun Huo (Ministerial Fire) is supreme. Therefore, Jia-Ji Earth Transport is considered Nan Zheng (Southern Governance), facing south to issue orders. The remaining four transports are Bei Zheng (Northern Governance), facing north to receive orders. For details, see chapters such as "Qi Yun" and "Five Years and Six Transformations." This explains why one must "first know the annual Qi." If a year suddenly has excessive rain, people’s diseases are mostly due to Dampness. One should use bitter-cold herbs like Atractylodes Rhizoma (Cangzhu) and White Atractylodes Rhizome (Baizhu) to dry dampness, assisted by wind-dispelling herbs, because wind can overcome dampness. This is what is meant by "first knowing the annual Qi." "Do not harm the Harmony of Heaven" means nourishing Yin in Spring and Summer, and nourishing Yang in Autumn and Winter. In Spring and Summer, Ephedrae Herba (Mahuang) and Cinnamomi Ramulus (Guizhi) are prohibited; in Autumn and Winter, Gypsum Fibrosum (Shigao), Anemarrhenae Rhizoma (Zhimu), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), and Paeoniae Radix Alba (Shaoyao) are prohibited. This is what is meant by "do not harm the Harmony of Heaven."

Do not make excess conditions more excessive, nor deficiency conditions more deficient, thereby bringing heavenly disasters upon people.
Wang Bing stated: If one does not examine excess and deficiency but only thinks of attacking, then excess becomes more excessive and deficiency becomes more deficient. All kinds of diseases worsen from this, true Qi diminishes day by day, and the disease pathogen invades day by day. The coming of disaster is like a heavenly calamity, impossible to escape. How sad!
Wu Kun stated: Making excess more excessive and deficiency more deficient is harming the Harmony of Heaven.
Ma Shi stated: Tonifying when the pathogenic factor is excessive is called "Sheng Sheng" (making excess more excessive), which is also called attracting pathogenic factors. Purging when the healthy Qi is deficient is called "Xu Xu" (making deficiency more deficient), which is also called losing healthy Qi. Thus, one brings heavenly disasters upon people and cuts off their long life.
Zhang Jiebin stated: When pathogenic factors are excessive, assisting them makes them more excessive. When healthy Qi is depleted, attacking it makes it more deficient. Not knowing excess and deficiency and blindly applying purgation and tonification causes the deficient to become more deficient, true Qi to diminish day by day, and pathogenic Qi to become stronger day by day. Bringing heavenly disasters upon people is the fault of the physician.
Zhang Ji’s commentary: The concepts of deficiency and excess cover a wide range, such as pathogenic excess and healthy deficiency, healthy excess and pathogenic absence, Yang excess and Yin deficiency, Yin excess and Yang deficiency, intestinal excess and stomach deficiency, stomach excess and intestinal deficiency, or one being excessive while the other is deficient, mutual excess and deficiency, or becoming excessive due to generation, becoming deficient due to restriction, becoming excessive due to tonification, becoming deficient due to purgation, becoming excessive due to purgation, or becoming excessive due to tonification. These cannot be enumerated. In short, deficiency and excess are the root of all diseases, and purgation and tonification are the guidelines for treatment. The Classic says: "Where pathogenic factors gather, the Qi must be deficient." Whenever it speaks of deficiency, it refers to the depletion of essence and Qi. Whenever it speaks of excess, it refers to the victory of pathogenic factors. Therefore, deficiency leads to susceptibility to pathogens, and pathogens become excess. The Classic says: "Pathogenic factors becoming excessive constitutes excess; depletion of essence and Qi constitutes deficiency." If pathogenic factors are heavier than the root, then purgation serves as tonification, meaning there is tonification within purgation. If the root is heavier than the pathogenic factors, then tonification serves as purgation, meaning there is purgation within tonification. If applied appropriately, what need is there to worry about "making excess more excessive and deficiency more deficient"? The *Ling Shu: Zhong Shi* chapter states: "Purging when deficient is called 'Chong Xu' (double deficiency)." The *Ling Shu: Jiu Zhen Er Shi Yuan* chapter states: "When the Qi of the five Zang organs is exhausted internally, but the acupuncturist instead strengthens the exterior, this is called 'Chong Jie' (double exhaustion)." Chong Jie and Chong Xu both refer to making deficiency more deficient. The *Su Wen: Ba Zheng Shen Ming Lun* states: "Tonifying during a full moon is called 'Chong Shi' (double excess)." Chong Shi is equivalent to Sheng Sheng. Also, the *Nan Jing: Twelfth Difficulty* states: "Tonifying Yin when Yang is exhausted, and tonifying Yang when Yin is exhausted, is called making excess more excessive and deficiency more deficient, damaging the insufficient and benefiting the surplus." The *Nan Jing: Eighty-first Difficulty* states: "In Lung excess and Liver deficiency, if the acupuncturist does not tonify the Liver but instead reinforces the Lung excessively, it is called making excess more excessive and deficiency more deficient." The principle is the same.

Do not attract pathogenic factors, do not lose healthy Qi, lest you cut off people’s longevity.
Wang Bing stated: This is what is meant by harming the Harmony of Heaven. Attacking deficiency as if it were excess is attracting pathogenic factors; failing to recognize the deficiency of the Zang organs is losing healthy Qi. Once healthy Qi is lost, it becomes the cause of death.
Wu Kun stated: Sheng Sheng is attracting pathogenic factors; Xu Xu is losing healthy Qi.
Zhang Zhicong stated: Pathogenic factors should be dispelled; healthy Qi should be nourished.
Zhang Jiebin stated: Making excess more excessive is attracting pathogenic factors; making deficiency more deficient is losing healthy Qi.
Zhang Ji’s commentary: Pathogenic and healthy Qi cannot coexist. Attracting pathogenic factors leads to losing healthy Qi; losing healthy Qi leads to attracting pathogenic factors. If application is inappropriate, both are lost. The Classic states that there are five types of pathogenic factors: those coming from behind are Deficient Pathogens; those coming from ahead are Excess Pathogens; those coming from the organ I cannot overcome are Robber Pathogens; those coming from the organ I can overcome are Slight Pathogens; and self-inflicted ones are Correct Pathogens. Pathogenic factors interfere with healthy Qi, and healthy Qi dispels pathogenic factors, so they cannot coexist.

The Yellow Emperor asked: For those with chronic diseases, if the Qi mechanism has harmonized but health has not returned, and the disease has passed but the body remains emaciated, what should be done?
Wang Bing stated: "Cong" means compliance or smoothness.
Wu Kun stated: Although the Qi mechanism is smooth, health is still not restored; although the disease has passed, emaciation is still seen.
Zhang Zhicong stated: This discusses how the human form is also nurtured by the support of Qi movements. When Shen (Spirit) departs, mechanisms cease; when Qi stops, transformation ends. Shen and Qi cannot fail to be regulated and nourished. However, Shen and Qi are like the master, and the form is like the vessel. Only when form and Shen are together can one fulfill their natural lifespan. Thus, the form cannot fail to be regulated and nourished. "Qi Cong" refers to Shen and Qi being regulated; "not healthy and emaciated" refers to the body being unhealthy while the form remains thin.
Ma Shi stated: This says that when a person is ill and emaciated, one should follow transformation and respect the seasons to await recovery. The Yellow Emperor asked: Regarding annual Qi, for chronic cases, the Qi is not yet healthy, and after the disease passes, the person is emaciated.
Qi Bo said: How profound is the Sage’s question! Transformation cannot be substituted, and time cannot be violated.
Wang Bing stated: "Hua" refers to creation/transformation. Attempting to replace a master carpenter chopping wood may still result in injury to one's hands; how much more so for the Qi of creation, can humans substitute it with force? Growth, development, storage, and elimination each correspond to the transformations of the Four Seasons. Even the most skilled and wise cannot cause them to occur prematurely. It is clear that this is beyond human power. From this perspective, the growth, development, storage, and elimination of all things require their proper timing. The success or failure, order or chaos of things also depend on timing. Since things are so, humans should be the same. Some say that force can definitely achieve results and substitute for creation, violating the Four Seasons; this is absurd.
Wu Kun stated: This indicates that transforming things must wait for Heavenly Work; human effort is insufficient to substitute. Heavenly time must be followed and not violated; forcing growth to accelerate transformation is incorrect.
Zhang Zhicong stated: "Hua" refers to the transformation of the Five Movements, where Qi replaces and succeeds one another. "Shi" refers to the principal times of the Six Qi; violating them is rebellion. For example, in the Ji of Fu He, the corresponding Zang is Liver, nurturing sinews; in the Ji of Sheng Ming, the corresponding Zang is Heart, nurturing blood; in the Ji of Bei Hua, the corresponding Zang is Spleen, nurturing flesh; in the Ji of Shen Ping, the corresponding Zang is Lung, nurturing skin and hair; in the Ji of Jing Shun, the corresponding Zang is Kidney, nurturing bone marrow. Thus, the skin, flesh, sinews, and bones of the form are all nurtured by transformation and movement and cannot be replaced. Similarly, Spring Qi nurtures sinews, Summer Qi nurtures blood vessels, Late Summer Qi nurtures muscles, Autumn Qi nurtures skin and hair, and Winter Qi nurtures bone marrow. Thus, the skin, flesh, sinews, and bones are all nurtured by the Qi of the Four Seasons, and time cannot be violated.
Ma Shi stated: Qi Bo said that Heaven and Earth have natural transformation, which cannot be replaced by human power, hence "No substitution for transformation." Creatures have times of success and failure, which cannot be violated by private wisdom, hence "No violation of time."
Zhang Jiebin stated: "Hua" refers to creation. The way of creation varies in decline and prosperity. For instance, Wood transforms in Spring, Fire in Summer, Metal in Autumn, and Water in Winter. The Four Seasons have different transformations, and the Five Movements and Six Qi each have their dominion, none of which can be substituted by human power. Hence, "Transformation cannot be substituted." Human Zang Qi must also follow these changes in decline and prosperity. To restore the deficiency of Zang Qi without relying on seasonal Qi is impossible; hence, "Time cannot be violated." Not violating time means, for example, that Metal and Water root in Spring and Summer, while Wood and Fire are based in Autumn and Winter. Zang Qi all have sources of transformation. If not prepared in advance, restoration may not occur easily at certain times, or pathogenic factors may take advantage of the deficiency again. Even with divine skill, nothing can be done.
I note: All commentators on this section believe that Heaven and Earth have natural transformation, and human power is insufficient to substitute, hence "Transformation cannot be substituted." If so, should we just let it be? But the following text says "nourish and harmonize," so what is the purpose? Is it not to use human effort to assist Heavenly Work? Is this interpretation not correct?
Zhang Ji’s commentary: The Classic says: "Not knowing the addition of the year, the prosperity and decline of Qi, and the origin of excess and deficiency, one cannot be a competent physician." Wang Bing believed that Heaven distributes Qi without departing from the Five Elements. Humans are within Qi; how could they not respond to Heavenly Dao? Therefore, "Transformation cannot be substituted, and time cannot be violated." One should follow the prosperity and decline of Yin and Yang in Qi and Movement as the subtle principle for dispelling disease and nourishing life. This principle must indeed be known but should not be rigidly adhered to. Miao Zhongchun said: The Five Movements and Six Qi are virtual applications. If the year has this Qi arriving, calculate it; if not, do not calculate it. If there is no such Qi, why use such medicine? Moreover, internal and external causes are felt according to time. Excessive movements also have times of insufficiency, and insufficient movements often have issues of excess. If one strictly sticks to Qi and Movement, can one avoid "making excess more excessive and deficiency more deficient, damaging the insufficient and benefiting the surplus"? Also, weather anomalies occur: Winter sometimes warms, Summer sometimes chills, Spring sometimes dries, Autumn sometimes warms. Spring Qi moves west, Autumn Qi moves east, Summer Qi moves north, Winter Qi moves south. In lowlands, Spring Qi is always present; in high hills, Winter Qi is always present. The Northwest is windy, the Southeast is damp. Localities differ, and diseases vary. In the Northwest, Qi is dense; how can everyone be solid? In the Southeast, Qi is thin; how can everyone be deficient? Prolonged drought leads to hyperactive Yang; prolonged rain leads to hyperactive Yin. Those with Yang excess endure Autumn and Winter but not Spring and Summer; those with Yin excess endure Spring and Summer but not Autumn and Winter. Weather anomalies lead to diverse human constitutions. Differences in altitude and geography mean that substituting transformation and violating time require separate discussion. Qi Bo stated this to clarify the constant laws of Heavenly and Annual Qi. Physicians who understand these can handle variations outside the laws of Heavenly and Annual Qi, achieving completeness without flaws.

If meridians are unblocked, Blood and Qi can return and recover. Their insufficiency becomes equal to that of others. Nourish and harmonize them, quietly awaiting the time. Guard the Qi carefully, do not let it shift or collapse. Then the form will manifest, and vital Qi will grow. This is called the Sage King. Thus, the *Da Yao* states: Do not substitute transformation, do not violate time, must nourish, must harmonize, await its recovery. This is what is meant. The Yellow Emperor said: Good.
Wang Bing stated: *Da Yao* is an ancient classic method. It cites ancient key principles to show that seasonal transformation cannot be violated and cannot be substituted by force.
Wu Kun stated: *Da Yao* is an ancient book stating that one cannot substitute Heavenly transformation, and one cannot act against Heavenly time. In the *I Ching* Hexagram Fu (Return), one Yang line arises below five Yin lines, representing the image of Yang returning. Thus, when transformation arrives, vital Qi gradually grows, called "recovery."
Zhang Zhicong stated: Meridians and collaterals are used to circulate Blood and Qi and manage Yin and Yang. Blood is Shen Qi. If meridians are open and Blood and Qi return smoothly, the insufficiency of Shen Qi becomes identical to that of a healthy person. This means Shen Qi has recovered, but the body is not yet healthy and the form remains thin. Therefore, one should quietly nourish Shen, harmonize Qi, await the time, guard Qi carefully, and prevent it from shifting. With the nourishment of seasonal transformation, the form will gradually manifest. This is the major principle of Qi and Movement for nourishing the body.
Ma Shi stated: For chronic illness without health and emaciation after disease removal, meridians are open, and Blood and Qi are smooth. The insufficiency of Zang organs should be restored to match sufficient ones. One must nourish and harmonize, quietly awaiting the time, so the form naturally manifests and is not emaciated.
Zhang Jiebin stated: After disease removal, if recovery is not sought, Yuan Qi declines and leads to emaciation. "Nourish" means nourishing with flavors and aromas; "harmonize" means harmonizing with temperament; "quietly awaiting the time" means preparing in advance to await recovery. For example, those with Yang deficiency prefer Spring and Summer; those with Yin deficiency prefer Autumn and Winter. Diseases in the Liver heal in Summer; diseases in the Heart heal in Late Summer; diseases in the Spleen heal in Autumn; diseases in the Lung heal in Winter; diseases in the Kidney heal in Spring. All follow this principle. Guarding Qi carefully prevents loss, allowing daily renewal. This is the way of dissolution, allowing vital Qi to gradually grow. *Da Yao* is an ancient book title. Here, ancient words are cited to show that transformation cannot be substituted, time cannot be missed, nourishment and harmony are essential, and waiting for recovery ensures it will happen. There is no case of non-recovery. The meaning of recovery is the same as the *I Ching* Hexagram Fu: one Yang arises below five Yins; as Yang gradually returns, vitality gradually grows. Same principle.

In the *Su Wen: Liuyuan Zhengji Dalun*, the Yellow Emperor asked: What happens if toxic medicines are used on a pregnant woman? Qi Bo answered: If there is a cause, there is no destruction [of the mother], nor destruction [of the fetus].
Wang Bing stated: "Cause" refers to large, hard masses (Jia Zha). If pain is unbearable, treat with medicines that break accumulations and resolve masses. This is called "if not saved, must die completely; save by risking complete death," preserving the greater good. Even taking toxic medicine, one does not die. "No destruction above" means the mother is preserved; "no destruction below" means the fetus does not die.
Wu Kun stated: "Zhong" is pronounced flat tone; "Zhong Shen" means pregnancy. "Du" refers to harsh medicines. As mentioned below, for causes like accumulations, urgent pain, and desire to die, only harsh medicines can bring life.
Ma Shi stated: This discusses the use of toxic medicines in pregnant women: they can be used but not overused. Pregnancy is called Zhong Shen. Using toxic medicines to treat disease works precisely because there is an internal cause; the disease bears the toxic medicine, so the fetus is not destroyed. Not only is the fetus preserved, but the mother is also not harmed.
Zhang Jiebin stated: "Zhong Shen" is pregnancy. "Du zhi" refers to potent/drastic medicines. As in the case of large accumulations and masses below, having the cause allows using the medicine. This is "when there is disease, the disease receives it." Thus, the pregnant woman suffers no destruction, and fetal Qi is not harmed. "Yun" means injury.
Zhang Ji’s commentary: "Zhong Shen" in *Su Wen: Qibing Lun* refers to a pregnant woman in her ninth month... "Zhong Shen" means pregnancy. In *Jin Gui Yao Lue: Ren Shen Pian*, if a woman had a pre-existing mass (Zhen) before menstruation stopped for less than three months and experiences continuous bleeding with fetal movement, the navel area is affected by the mass. If movement occurs at six months, it relates to menstrual blood at three months prior; bleeding occurs three months after cessation of menses for the embryo. The reason bleeding continues is that the mass has not been removed. The mass should be removed using Guizhi Fuling Wan (Cinnamon Twig and Poria Pill). Shen Mingzong stated that if the mass is not removed, it obstructs fetal blood from entering the fetus, causing bleeding. The mass should be removed, but Danpi (Moutan Cortex) and Taoren (Persicae Semen) are taboo for the fetus. Taking one pill grinds it down gradually without disturbing the fetus. You Yi stated that if the mass is not removed, blood does not stay; if blood does not stay, the fetus is never safe. This pill’s power to remove masses is mild and slow, fearing that drastic medicines would harm fetal Qi. Xu Bin said: This pill uses Guizhi and Shaoyao (one Yang, one Yin), Fuling and Danpi (one Qi, one Blood), and Taoren to break bad blood and eliminate masses without worrying about harming the fetus because the disease bears it. There are many formulas for removing masses, but this pill is excellent.

The Yellow Emperor asked: I wish to hear the reason. What is meant by this? Qi Bo said: For large accumulations and masses, they can be attacked, but stop when they have diminished by more than half. Exceeding this leads to death.
Wang Bing stated: Diminishing by more than half is insufficient to harm life, so stop when diminished by more than half. If medication is continued excessively, waiting for toxins to remain inside, there is no disease left to attack, yet one uses toxic medicines. Unchecked toxic attacks damage the Middle Harmony, hence exceeding leads to death.
Wu Kun stated: Stopping when diminished by more than half means True Qi is injured but not severely damaged. Exceeding this means True Qi is gone, hence death.
Zhang Zhicong stated: This says that fetal pregnancies and accumulations also have divisions of Yin/Yang and Cold/Heat. One should avoid Cold and Heat. "Du" refers to extremely Cold or Hot medicines. In the first and second months of fetal formation, Wood Qi governs nourishment; third and fourth months, Fire; fifth and sixth, Earth; seventh and eighth, Metal; ninth and tenth, Water. By Tai Yang, the Five Elements are complete, and Yin/Yang Water/Fire divide to form the postnatal body. However, before birth, the Qi of the Five Elements has prosperity and deficiency, victory and depression. They should be regulated with Cold, Heat, Warmth, Coolness, Compliance, and Rebellion. If illness occurs and one does not avoid Cold or Heat, it will not harm fetal Qi, called "if there is a cause, no destruction." However, one must not exceed this to cause destruction. For example, large accumulations and masses belong to the Five Elements of Zang-Fu organs. It is permissible to attack Cold or Heat. If exceeded, death results. Cold, Heat, Warmth, and Coolness are called the Four Feared Things. Can one not be cautious? This section is crucial for medical practice; students should reflect carefully. Also, infants born in the seventh month can survive and often live long. This is because the seventh month is governed by the Lung Zang. Lung belongs to Heaven, governs Qi and Blood, and Heaven generates Water. Feeling the Qi of Heaven and Earth leads to survival. Infants born in the ninth and tenth months are governed by Shao Yin and Tai Yang, feeling Yin/Yang Water/Fire. However, the eighth month is governed by Yangming Large Intestine Qi. Feeling Yangming Fu Qi leads to birth but inability to survive.
Zhang Jiebin stated: Although pregnant, if there are large accumulations and masses, toxic medicines are needed to attack, and attacking causes no harm, hence it is permissible. However, one should only diminish by more than half and then stop medication, as in "Great toxicity treats disease, remove six-tenths." If overused, the disease may not be fully cured, but the fetus is injured, often leading to death.
Zhang Ji’s commentary: *Su Wen: Sishi Ni Cong Lun* states: Jueyin pulse choppy indicates abdominal Qi accumulation; Shaoyin choppy indicates accumulation and bloody urine; Taiyin choppy indicates abdominal fullness; Yangming choppy indicates accumulation and frequent fright; Taiyang choppy indicates accumulation and frequent head disorders; Shaoyang choppy indicates accumulation, frequent tendon spasms, and eye pain. *Ling Shu: Bai Bing Shisheng Pian* states: Accumulations begin with Cold, leading to reversal and forming accumulations. Fluids and blood mix, condense, and cannot disperse, forming accumulations. Tonify when appropriate, purge when appropriate. *Ling Shu: Wu Bian Pian* states: Pathogenic factors lingering cause accumulations; slight pathogenic factors accumulate and stop, forming large masses. *Jin Gui Yao Lue: Ji Ju Pian* states: Diseases have Ji (accumulations) and Ju (gatherings). Ji diseases do not move; Ju diseases move around and are treatable. A fine pulse attached to the bone indicates accumulation. Inch position accumulation is in the chest; slightly beyond inch is in the throat; Guan position accumulation is near the navel; above Guan is in the heart; slightly below Guan is in the lower abdomen; Chi position accumulation is in Qichong. Pulse emerging on the left indicates left accumulation; right indicates right; both indicate middle. Locate according to部位. If no accumulation anteriorly, seek Zang deficiency and tonify. Comparing these clarifies the meaning.

In the *Su Wen: Zhi Zhen Yao Da Lun*, the Yellow Emperor asked: Discussions state treating Cold with Heat and Heat with Cold. Yet physicians cannot abandon rules and change the method. For patients with Heat, cooling makes them hotter; for patients with Cold, heating makes them colder. Both result in new diseases recurring. How to treat?
Wang Bing stated: Treatment fails to reduce the disease; instead, due to the Cold/Heat of the medicine, Cold/Heat symptoms arise anew. These are new diseases. Some recur after stopping; some resolve while taking medicine but recur after stopping; some never cease. If physicians abandon these rules, there is no new method. Adhering to standards fails to remove disease trends; intervening blocks common understanding; treating yields ineffective medicine. Mind confused, intent perplexed, unable to comprehend, not knowing what reliance to use for the Way. Due to medicine causing disease, old and new oppose each other. How can one seek cure?
Wu Kun stated: "Cooling makes hotter" means cooling results in persistent Heat; "heating makes colder" means heating results in persistent Cold.
Ma Shi stated: This discusses standard treatment failing to cure because one does not seek the underlying affiliation, perhaps focusing only on Wang Qi (Dominant Qi) or biasedly using Five Flavors. Treating Heat with Cold leaves Heat disease intact; treating Cold with Heat leaves Cold disease unresolved, even causing new diseases to recur. Why?
Zhang Ji’s commentary: Cold and Heat originate from Yin and Yang. Treating Cold with Heat and Heat with Cold: Hot medicines originate from Summer growth of all things; Cold medicines originate from Winter killing of all things. Extreme Yuan Qi deficiency must involve Cold; use Acrid-Hot to tonify. Excessive pathogenic factors reaching extremes require suppression; use Bitter-Cold to purge. In short, Warm-Hot medicines should tonify deficiency-Cold; Cold-Cool medicines should purge Excess. If one does not distinguish excess and deficiency and generally administers Cold-Cool medicines, Yang Qi is injured. Without Yang, Yin cannot generate; without Yin, Yang cannot transform. Thus, old disease remains, and new disease recurs. New disease implies Yin-Yang discord; tonifying bias and saving弊端 temporarily uses bias. Chronic disease implies gradual weakening of Yin-Yang; supporting Yuan and nourishing Zheng requires neutrality. Administering heavy medicines for chronic disease, I fear it will sever life. Danxi biased towards tonifying Yin, yet stated: Excess Fire can be purged with Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian); Deficient Fire can be tonified with Ginseng Radix (Renshen) and Astragali Radix (Huangqi). One can understand the use of Cold and Heat.

Qi Bo said: For all cases treated with Cold that remain Hot, treat the Yin. For all cases treated with Heat that remain Cold, treat the Yang. This is called seeking the affiliation.
Wang Bing stated: This means "benefit the source of Fire to dissipate Yin shadows; strengthen the master of Water to control Solar brightness." Hence, "seek the affiliation." Crude physicians are narrow-minded and shallow, lacking deep learning. Using Heat to attack Cold and Cold to treat Heat: treating Heat has not finished, yet Cold disease arises; attacking Cold deepens, yet Heat disease rises. Heat rises while Middle Cold remains; Cold generates while Exterior Heat persists. Wanting to attack Cold fears Heat, holding back; wanting to treat Heat considers Cold, stopping. Advance and retreat clash, danger reaches extreme. How could they know the source of Zang-Fu has masters of Cold, Heat, Cool, and Warm? Treating Heart does not necessarily align with Heat; treating Kidney does not necessarily align with Cold. Simply benefit Heart Yang, and Cold also circulates; strengthen Kidney Yin, and Heat is observable. Thus, treating Heat with Heat and Cold with Cold achieves ten thousand successes. Who knows their meaning? Thinking deeply, logic exhausted, words failed. Alas! Do people die because of fate, or because physicians are ignorant and kill them?
Wu Kun stated: Wang’s note on "benefiting and strengthening" seeks what is beneficial, initially not sticking to traces of Cold and Heat.
Zhang Zhicong stated: This discusses methods for when Cold/Heat treatments do not respond. Cold not resolving indicates True Yin deficiency; Heat not resolving indicates True Yang deficiency. Thus, disease does not resolve, and long-term use of biased Cold/Heat creates disease. Therefore, one must seek the affiliation to reduce it. "Affiliation" means category, referring to Water/Fire and Cold/Heat of the same category among the Five Zang. "Treating Yin" and "treating Yang" mean tonifying Yin and tonifying Yang respectively. Treating Heat with Cold and Cold with Heat is the standard method; tonifying Yin to overcome Heat and tonifying Yang to overcome Cold is the counter-assistance method.
Ma Shi stated: Humans have Five Zang. Kidney Meridian belongs to Water, Yin. Now, treating with Cold still results in Heat; one should treat the Yin Meridian, called "strengthening the master of Water to control Solar brightness." Heart Meridian belongs to Fire, Yang. Now, treating with Heat still results in Cold; one should treat the Yang Meridian, called "benefiting the source of Fire to dissipate Yin shadows." This is all seeking the affiliation of the original meridian.
Zhang Ji’s commentary: Yin and Yang are abstract names; Water and Fire are physical realities. Cold and Heat are Heaven’s excessive Qi; Water and Fire are Human’s True Yuan. Excessive Qi causes disease; attacking with Cold/Heat medicines harms True Yuan. Use the truth of Water and Fire to regulate. However, without seeking affiliation, administration fails to enter. Prenatal Water and Fire originally belong to the same palace. Fire takes Water as master; Water is the source of Fire. Thus, treating Yin seeks Water within Fire, ensuring essence does not deplete; treating Yang seeks Fire within Water...