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(Zhang) Because he was frequently ill in his childhood, he abandoned Confucian studies to learn medicine. He followed teachers, sought the Dao, compiled and read various books, studied bitterly for ten years, and only then dared to practice clinically. He strictly followed the standards of ancient sages, working diligently and cautiously, saving many lives. With long experience, his insights became subtle and profound, difficult to fully express in words.

Generally, as established by former sages: For external contraction where wind injures the Wei (Defensive Qi), use acrid-warm herbs to disperse the exterior; where cold injures the Ying (Nutritive Qi), use acrid-hot herbs to dissipate. If the disease persists, follow with harmonizing methods; if harmonizing fails and the pathogen transmits inward, employ purgative methods to rescue the interior. Once the pathogen is resolved and recovery begins, use methods to regulate Yuan Qi and restore the root. If the condition is critical, there are also decoctions for warming meridians, benefiting Yuan Qi, treating mishandled cases, or rescuing life, all purely focused on saving the root. For internal injury due to overexertion, immediately use regulating and tonifying methods without further differentiation. For internal injury due to dietary accumulation, first employ digestion-promoting methods; if the disease persists, follow with purgatives; after recovery, regulate the Spleen and Stomach. If encountering patients with weak constitutional Yuan Qi, one may combine draining and tonifying, tonify more than drain, or tonify before draining. These are established methods, clearly categorized and sequential, never ineffective.

However, these methods are most suitable for people of ancient times, who had strong constitutions, and commoners, whose middle jiao and exterior were solid. They could withstand the consumption of disease and the scouring action of treatment, not easily damaging their deep Tian Yuan (Heavenly Origin), thus preserving their longevity to a hundred years. They are not suitable for people of later generations, whose acquired Qi is thin, whose natures are depleted, and who are pampered youths with delicate constitutions. Slight cold can injure the exterior; labor or improper diet easily injures the middle. Once diseased, their Shen Qi becomes depressed. Adding attacking and draining methods accelerates their deficiency and danger. They cannot withstand prolonged disease consumption nor gradual drug treatment. Often, conditions suddenly worsen, spirit approaches extinction, and only then are harsh tonics administered to rescue. For those already collapsed, it is too late; for those not yet collapsed, survival is merely luck.

Moreover, such previous treatment methods only temporarily remove pathogens, allowing spirit to return to its origin, enabling one to live out a medium lifespan, but cannot permanently eliminate pathogens or make Yuan Qi exceed normal limits to achieve immortality. One fails to consider the *Jing* (Classic) saying: "If spirit is kept within, how can disease arise?" And again: "Where pathogen gathers, Zheng Qi must be deficient." If one does not treat the deficiency, what else is there to ask about? Former sages' treatment methods possessed insight into the root, focusing solely on the foundation, treating thousands without causing harm, which are supreme truths. Know that those prone to wind diseases have inherently weak exterior Qi; those prone to cold diseases have inherently weak interior Qi; those prone to heat diseases have inherently deficient Yin Qi; those prone to food stagnation have inherently deficient Spleen and Stomach; those prone to labor injuries have inherently damaged Middle Qi. This is not due to excess of pathogenic factors, but truly summoned by deficiency of Zheng Qi. Before illness, deficiency exists; during illness, deficiency increases. Using draining drugs makes deficiency worse; using tonics merely compensates for what was drained. Even if recovered to normal, spirit remains timid. Understand that when symptoms appear excessive, it is precisely when Zheng Qi is insufficient. Why not, when suffering from wind, use acrid-warm methods to protect Wei Qi? When suffering from cold, use acrid-warm methods to transform Ying Qi? When suffering from heat, use sweet-bitter methods to overcome Yin deficiency? When suffering from stagnation, strengthen Middle Qi to assist transportation? When suffering from labor, cultivate Yuan Qi to restore balance? Let Zheng Qi circulate freely to expel pathogens. When pathogens are eliminated and Zheng Qi restored, pathogens cannot overcome Zheng Qi and naturally dissolve. Transform old to generate new, releasing guest pathogens effortlessly. Zheng Qi regenerates at the time of injury. Add nursing care, not only eliminating new diseases, but also eradicating old ailments through this method. Unknown to the disease root, generating Qi and Blood for a long time, is this not joyful!

Furthermore, the increase or decrease of spirit depends on the flourishing or declining of Yin and Yang; Yin and Yang changes depend on the waxing and waning of Water and Fire, all of which are formless. External six excesses and internal seven emotions are also formless; only dietary stagnation has traces, yet it is actually operated by Qi transformation, also formless. Treating formless pathogens interfering with formless Zheng Qi requires treating them as formless phenomena, adjusting through the interaction and transformation of drug flavors and natures, not treating them as有形 (formable) entities to attack formless deficiency. The word "attack" mentioned in books is detested by benevolent people. Moreover, when cold transforms into heat, cold is the original cause of guest pathogen disease; heat is the outward flare of touched Yuan Yang. After removing cold, if one again disperses it, it accelerates the dissipation of deficient Yang. When food injures the Stomach, the Spleen becomes deficient as well. With Stomach Qi deficient, the endowment of Zang-Fu organs is lost. At this time, although food rots and digests internally, neither internal organs nor external limbs have Qi to move. If one eliminates food after it has already transformed, one risks severe double deficiency. Therefore, it is crucial to judge via pulse. Though有形 (formable) symptoms vary, they all stem from one formless root. For diseases with traces but formless essence, still use drugs with traces but formless essence, following affinity of Qi categories, so administration enters effectively. Generally, plants grow within human body Qi and Blood; treating disease with drugs also requires selecting herbs with emotional connection to Qi and Blood, naturally assisting blood and Qi to expel disease. Thus, Qi and Blood drive powerfully with drug momentum, while drug force protects Qi and Blood without injury. When Zheng Qi is robust, pathogens are quickly resolved. If one recklessly throws wild wolf-tiger-like dangerous and toxic drugs, one injures Zheng Qi before expelling guest pathogens. Injured Zheng Qi allows pathogens to consolidate. Named expelling pathogens, actually damaging Zheng Qi. Hence, the value lies in "treating by not treating," utilizing formless divine efficacy.

(Zhang) In thirty years of clinical practice, I have never encountered a single case of Shanghan (Cold Damage). For example, ancient descriptions of high fever and headache characteristic of Taiyang syndrome: without using Mahuang (Ephedra), Guizhi (Cinnamon Twig), Qianghuo (Notopterygium), or Chaihu (Bupleurum), the disease resolves itself. How can one know theories of meridian transmission? For malaria caused by extreme cold and heat: why use Qingpi (Citrus Peel), Binglang (Areca Seed), Chenpi (Tangerine Peel), Banxia (Pinellia), Chaihu, or Huangqin (Scutellaria)? Cold and heat resolve spontaneously. For dysentery with abdominal pain and mixed red/white discharge: why rely on Xiangfu (Cyperus), Lianhua (Lotus Flower/Honeysuckle - likely referring to Lianpu or similar clearing herbs, context implies clearing heat/dampness), Qingpi, Chenpi, Binglang, or Houpo (Magnolia Bark)? Bowel movements regulate themselves. For food stagnation with chest fullness, belching, foul odor, and aversion to food: without relying on Shanzha (Hawthorn), Shenqu (Medicated Leaven), Sanleng (Sparganium), or Baizhu (Atractylodes), food digests itself. For lung distension with phlegm obstruction causing cough: without relying on Juhong (Tangerine Pith), Banxia, Sangbaipi (Mulberry Root Bark), or Beimu (Fritillaria), phlegm and cough heal themselves! Once trace-based diseases are removed, formless Yuan Qi instead grows. Therefore, examine the cause, seek the affiliation, avoid excess, follow deficiency, stabilize Zheng Qi, transform pathogens, restore Yuan, overcome old patterns. The *Jing* says: "Do not induce pathogens, do not lose Zheng Qi, and you will long possess your heavenly mandate." This is what is meant. It is like a righteous army, invincible under heaven. This is (Zhang's) method of seeking perfection beyond standard rules, aligning with the *Neijing*'s "If you do not treat deficiency, what else is there to ask?" and the former sages' principle of identifying the mark to take the root.

(Zhang) Commentary: What sustains human life relies solely on a spark of True Yang Qi. Even when hundred diseases present with fever, none arises except when Mingmen Fire leaves its palace. If fire rests in its proper position, all diseases cease. Thus, ancients earnestly warned against using cold-cool drugs, saying: "Those who take cold-cool drugs, one in a hundred survives." And again: "Those who mistakenly take cold-cool drugs die instantly." Showing the severe and rapid harm of cold-cool drugs, warning caution against light or mistaken use. For extremely deficient and critical conditions, the main focus is entirely on rescuing Yang. As long as one part of Yang Qi remains, death does not occur. However, exhaustion of Yang Qi has two types: If six pulses are deep and minute, and both Chi (Kidney) positions lack root, this is Yuan Yang of Yuan Qi about to exhaust; only Renshen (Ginseng), Muxiang (Aucklandia), and Fuzi (Aconite) can salvage it. If six pulses are fine and rapid, and both Chi positions lack root, this is Yuan Yang within Yuan Yin about to deplete; only Dihuang (Rehmannia), Zhuyu (Cornus), Rougui (Cinnamon Bark), and Fuzi can salvage it. Once Dragon-Lei false fire retreats, and pulses change from fine-rapid to deep-minute, then drugs like Dihuang, Zhuyu, Rougui should change to Renshen, Baizhu, Fuzi. Thus, even for hematemesis with Yin deficiency, success is often achieved with Spleen-Stomach regulating drugs. However, for harsh tonics, if six pulses have root and Chi pulse is unbroken, recovery is easy to see effect. Like trees with roots, adding fat and irrigation makes them easily sprout and flourish. If six pulses lack spirit and Chi pulse lacks root, recovery is hardest to see effect. Because root Qi is lost, relying only on drug force to recover; if drug force slows slightly, collapse comes immediately. Only heavy, continuous supplementation can turn around the mechanism of life generation. Like cultivating rootless plants, relying entirely on soil to support, water to nourish, sun to warm, making Yang-harmonious Qi warm and moisten continuously, only then can rootless become rooted. Must take three to five days for slight turning, seven days to recover. Gradual slow progress is indeed difficult. However, ancient formulas for rescuing collapse used only one liang of Renshen and half a raw Fuzi, considered powerful life-saving drugs. Alas, modern people's Yuan Yang deficiency is more severe, while Renshen's tonifying power is weaker. Often administering this formula yields little result. (Zhang) Reflects that Fuzi penetrates meridians and collaterals, requiring Renshen's great power to drive it; otherwise, its rapid penetration damages Yuan Qi. Thus, ancients had formulas like Renshen-Fuzi, Baizhu-Fuzi. Fuzi must be used with Renshen and Baizhu, aiming to penetrate meridians while supplementing its scattering nature. Unfortunately, Heaven and Earth Qi transformation has thinned; humans and herbs are endowed with deficiency. Renshen's power is not like before. If one uses one liang of Renshen and half a raw Fuzi, scattering exceeds tonifying, how can it hold True Yuan? Therefore, (Zhang) whenever treating collapse, uses three to four liang of Renshen, and only then administers half a cooked Fuzi. For extreme cold and critical conditions, even Renshen's power may be insufficient to rescue. Since Renshen is mild, one must additionally use Baizhu, which tonifies rapidly and has rigid strength, to scatter deep cold and追回 (retrieve) Yuan Yang. Moreover, Yang deficiency focuses on the Stomach. If one does not heavily support Middle Qi, although Fuzi has power to retrieve Yuan Yang, its penetrating nature contains scattering mechanisms. Like repairing a broken house, if one does not first use large timber to prop up beams, but rashly uses axes and saws to pierce and shake, can one guarantee the house won't collapse and beams won't break? Additionally, for Zang-Fu deep cold and solid closure conditions, using warm-tonic drugs to circulate Qi: for thin/small bodies, use small doses decocted thick to ensure coverage. For large/heavy bodies, must use large doses drunk copiously to reach everywhere. Since bulky bodies have heavy Yin endowment, non-Yang drugs doubled are insufficient to overcome it.

I treated the father of Mr. Xiong from the Hanlin Academy, over seventy years old. After eating, he was startled, leading to incessant vomiting. Food expelled completely, followed by phlegm-saliva. Eyes rolled back, body feverish, face red, mouth open, head tilted back, hands convulsing. From Wu hour to Xu hour, sweating profusely like rain. Urgently summoned me to diagnose. Six pulses were wide and empty—this was False Yang floating upward. Prescribed Renshen two liang, fried Baizhu three liang, processed Fuzi five qian, Wuweizi (Schisandra) two qian. Decocted thick and灌服 (force-fed). Initially, convulsions stopped, sweat ceased, fever subsided, body calmed. But remained comatose. Next day, continued same formula, morning and evening one dose each. After three days, finally clear-headed, recognized people, could eat thin porridge. Subsequently used Shiquan Dabu Tang (Ten Significant Tonifying Decoction) and Renshen Yangrong Tang (Ginseng Nourishing Spirit Decoction) until stable. Another case: Mr. Zhou, fifty-plus years old. Always had excess Heart-Lung Fire, but deficient Spleen-Kidney Yang. Frequently suffered asthma attacks, each threatening life. In summer, labor-induced fever occurred. Mistakenly used Xiangru (Elsholtzia) for clearing summerheat, Liuyisan (Six-Ingredient Powder), ice water, and craved watermelon excessively. Resulted in lower jiao blockage, upper jiao heat worsening. Restlessness, panting urgency, long abstinence from food. Pulses fluctuated large and small, Chi positions lacked root. Gradually became intermittent, deep-minute, slow, stopping every three beats, constantly near collapse. Summoned me for treatment. Urgently prescribed Renshen three liang, Baizhu four liang, Paojiang (Roasted Ginger) three qian, Wuweizi two qian, processed Fuzi five qian. Decocted thick and灌服. After taking, pulse Qi slightly rose, Shen Qi slightly revived. Drug nature slightly passed, collapse tendency returned. Immediately repeated prescription. Daily Renshen increased to eight liang, Baizhu to ten liang, Fuzi to two liang. Gradually Chi pulses gained root, collapse tendency ceased. Then heavily added warm-tonics until cured. Observing this, modern deficiency is more severe than ancient times, and Renshen's power is weaker than ancient times, clearly visible.