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Delirium (confusion with incoherent speech) should be treated with Da Cheng Qi Tang (Major Order the Qi Decoction) to purge, which will lead to recovery. Tidal fever (fever that rises like the tide at specific times) indicates an excess syndrome in the interior. At this point, the exterior syndrome has resolved, and the interior can be attacked; however, if sweating is used instead, there is no Yin pathogen on the surface, and sweating further assists Yang. This results in Yang excess and supplements the exterior, leading to heat in both the interior and exterior. If death does not follow, what else could? The *Waitai Miyao* states: "When the exterior is harmonized but the interior is diseased, purging leads to recovery, while sweating leads to death." This expresses exactly this meaning.

Excessive sweating leads to loss of Yang (disipation of Yang Qi due to excessive diaphoresis): The elder brother of Qi Da contracted cold pathogens in winter, presenting with stiffness of the head and neck and body pain. He self-administered four or five pills of Lingsha Dan (Cinnabar Pill) taken with wine, resulting in profuse sweating, after which he felt light. By night, the previous symptoms returned. He took the same medicine again to induce sweating, but the illness did not resolve. He then used Tongsheng San (Universal Salvation Powder) to sweat, and the condition worsened: his body became heavy, his calves were cold, and he had aversion to cold. Only on that day did he summon a physician. The physician did not investigate the previous treatments and administered Wuji San (Five Accumulations Powder) to induce sweating. The next day, his body was as heavy as stone, unable to turn over; his feet were cold as ice, with coldness extending to the waist and back. Sweat on the head flowed like beads but did not drip, his chest and heart were restless and hot, he was agitated and uneasy, and desired to drink watermelon, pear, persimmon, and ice water, keeping them constantly by his side. When the condition reached this state, the family asked me to treat him. I palpated the six pulses, finding them fine as spider silk, faint and nearly imperceptible, and pronounced it a fatal case. The family said, "He has sweated profusely; how can this be harmful?" I replied, "Cold pathogens invading the human body are caused by insufficient Yang Qi. The severity of invasion varies; how can treatment be inappropriate? Zhang Zhongjing stated: 'In cases of Yin excess and Yang deficiency, sweating promotes recovery.' Sweating is intended to assist Yang and retreat Yin. Moreover, cold pathogens cannot cause spontaneous sweating; they require the release of Yang Qi to exit. Considering the season, generally, summer is suitable for sweating, but one must beware of excess. How much more so during the three winter months, which are times of closure and storage? One should not disturb Yang or open the skin pores, causing frequent depletion of Qi; this is the way to nourish storage. Violating this causes Shaoyin (Kidney system) to fail to store, which contradicts the adaptation to winter Qi. For any external contraction, slight sweating is appropriate, aiming for balance, stopping when pathogens recede. One should urgently wear warm clothes, reside in a sealed room, and take formulas that consolidate the exterior and supplement Wei Qi (Defensive Qi). Even if cold pathogens exist, they cannot cause harm; this is a flexible treatment. Now, inducing profuse sweating out of season is called 'contrary' treatment. Thus, Zhang Zhongjing said: 'One error may delay death, two errors accelerate it.' Here, the patient was injured by cold and simultaneously subjected to sweating; after sweating, injury occurred again, followed by more sweating. Profuse sweating several times caused frequent Qi depletion, leaving Wei Qi unguarded, Yang leaking outward, and Yin attacking inward. Hence, the classics say: 'Solitary Yang does not generate, solitary Yin does not grow.' If death does not follow, what else? Even Lu Yi (Bian Que) could not treat it. That night, near midnight, he developed neck stiffness, bodily numbness, convulsions of the hands and feet, and cyanosis of the nails, then died. The *Jingui Yaolue* states: 'Sweating when one should not, depletes fluids and leads to withered death.' Even proper sweating, if excessive, can cut off life; how much more so improper forced sweating?

Excessive purging leads to loss of Yin (depletion of Yin fluids due to excessive catharsis): A guest surnamed Zhao from Zhengding, in the sixth month of the Yichou year, was traveling. Due to fatigue and dampness exposure, he experienced epigastric fullness and oppression, intermittent restlessness and heat, and inability to sleep peacefully. He stayed in a temple where a monk recklessly gave him several pills of highly toxic medicine, causing more than ten episodes of diarrhea, slightly reducing the epigastric fullness. The next day, exhausted and sleeping, he was robbed of his belongings. Emotional agitation led to restlessness, heat, and thirst. He drank a large bowl of cold water, and that night suffered umbilical and abdominal distension and pain. The monk gave the same medicine again, causing another ten-plus diarrheal episodes. The illness worsened significantly: limbs were weak, restlessness persisted requiring constant clothing changes, desire for cold water remained, food was undigested, dysentery resembled rotten fish intestines mixed with red and yellow fluids, appetite was absent, forced eating caused vomiting, epigastric obstruction was worse than before, belching was incessant, feet were cold, and lower abdominal pain was unbearable. He requested my treatment. His pulse was floating and rapid, 8-9 beats per breath, empty upon pressure. Tracing the origin, the summer heat had already damaged righteous Qi. Administering highly toxic, hot-purgative medicine caused further damage. After one purge, the offending matter was expelled completely. However, the residual properties of Croton seed (Badou) remained, spreading toxicity in the stomach and intestines, causing nausea and inability to eat, further injuring Stomach Qi; continuous passage of pus and blood caused muscle wasting and dry skin/hair, indicating Spleen Qi weakness and decline. Redness and roughness on the tongue, dry throat, and insufficient fluids resulted from excessive purging depleting Yin. With Yin depleted, Heart Fire flared alone, causing chest/heart restlessness and agitation. The classics state: 'Solitary Yang does not generate, solitary Yin does not grow'; this is the cause of premature death. I declined the case and left. Later, other physicians treated him. Without examining the pulse or investigating the cause, seeing only fullness, they used Zhike Wan (Aurantii Fructus Pill) to purge. The condition worsened with wheezing and fullness, uncontrollable dysentery, and death. The *Jingui Yaolue* states: 'Purging when one should not causes intestinal opening and洞泄 (profuse watery diarrhea), leading to death with incontinence.' This describes the situation perfectly. Sages treat diseases with method; medication must not exceed limits. The *Neijing* says: 'For highly toxic medicines, remove 60%; for mildly toxic, 70%; for commonly toxic, 80%; for non-toxic, 90%. Then use grains, meats, fruits, and vegetables to complete recovery. Do not overdo it, as excess damages righteous Qi.' The *Liji* says: 'If a doctor has not practiced for three generations, do not take their medicine.' This shows extreme caution. That monk was not a medical professional; recklessly using highly toxic purgatives excessively killed the patient within days. The disaster of improper medication is thus. Choosing a doctor requires caution. Beware, beware.

Loss of dosage control (Fang Cheng Wu Yue): In the eleventh month of the Ding Si winter, returning from military service to Bianliang, a performer named Li Ren'ai told me: "My eldest son, since July this year, consumed cold tea and cold rice after labor and thirst, developing epigastric fullness. A doctor prescribed one dose, causing two bowel movements, reducing symptoms. Not long after, re-exposure to cold foods caused recurrent epigastric/abdominal fullness, vomiting, nausea, tastelessness, anorexia, limb fatigue, and reluctance to speak. The previous doctor examined him and said, 'This is easy to treat; a few more bowel movements will bring relief.' He prescribed Wuyou San combined with powdered Strychnos nux-vomica (Qian Niu), taken with plain water. By evening, borborygmus and colicky pain occurred. Soon, vomiting and diarrhea ensued, unremitting thirst, uncontrolled eating/drinking, and periodic unconsciousness. The doctor was summoned again but withdrew, unable to manage the pulse. Soon, cold sweat poured like washing, breath from mouth/nose grew cold, and he died. I regret deeply; may I ask why?" I said, "I did not witness it personally, so I do not know the exact reason, having left. Someone said, 'I witnessed it. Is it truly the fault of the medicine?' I said, 'It is not the fault of the medicine, but the failure of dosage control. Medicines without basis become thieves of Qi. The Neijing states: 'Regulating a prescription is like tying a bag. If a bag is full but not tied, it leaks. If a prescription is formed but not regulated, Shen and Qi will not accompany it.' Therefore, Zhang Zhongjing, using Guizhi Tang (Cinnamon Twig Decoction) for exterior wind, said: 'If sweating occurs after one dose and the disease resolves, stop subsequent doses; do not finish the decoction.' For Da Cheng Qi Tang treating severe excess/fullness, he said: 'Stop after changing clothes once; do not finish the decoction.' Such caution! This is a major warning, embodying the sage's principle of regulating the bag. Treating disease must seek the root. Li Ren'ai engaged in drama, exhausting Shen and damaging Qi. Epigastric pain arose from summer heat, thirst, drinking cold tea, weakening Spleen/Stomach Qi, failing to transform, causing fullness. Using purgatives further distressed the Spleen. Carelessness damaged Yang; deficiency compounded by injury, injury compounded by purging. Yin contends internally, Yang disturbs externally. Po Han (sweat) is not stored, Four Reversals arise internally. As Zhang Zhongjing said: 'One error delays death, two errors accelerate it.' Is this not a failure of dosage control? Thus, the Neijing warns: 'Superior doctors regulate Qi, middle doctors disrupt pulses, inferior doctors exhaust Qi.' One must be cautious.

Contraindication of purging in Tuo Ying (Depletion of Camp): The *Shu Wu Guo Lun* states: "Once noble, now humble; although not struck by pathogens, disease arises internally, named Tuo Ying." A scholar from Zhenyang was robust and heroic, sociable with ambitions, over thirty years old, holding a fifth-rank official position, surrounded by attendants and concubines, with all desires satisfied. Within three years, dismissed due to affairs. Mental depression and worry led to loss of appetite, declining spirit, and emaciation. Helpless, he indulged in alcohol, leading to abdominal fullness. Seeking a doctor, the physician failed to assess the condition properly and administered five pills with warm water, causing twenty-plus diarrheal episodes. It was early autumn, summer heat still prevalent, causing thirst and excessive cold water intake, leading to borborygmus, abdominal pain, and dysentery resembling fish brains, worsening to critical state. I examined him: pulse fluctuated between large and small, symptoms included repeated confusion, retching, and sighing. I predicted: "This is difficult to treat." Qixuanzi said: "Due to spiritual constriction." From nobility to humiliation, lingering attachment, knotting of will, worry, and fear, though not struck by pathogens, disease arises internally, blood vessels become deficient, named Tuo Ying. Someone asked for the rationale. The *Huangdi Zhenjing* states: "The path of Zong Qi relies on grain. Grain enters the stomach, transmits to vessels, flows溢出 (overflows) internally, spreads externally. Refined essence travels through meridians, cycling endlessly, nourishing continuously, constituting the rhythm of heaven and earth. Qi begins at Hand Taiyin, moves to Yangming, circulates to Foot Jueyin, follows the abdomen, enters the collarbone region, descends to the Lung, then returns to Hand Taiyin. This is the path of Ying Qi (Nutritive Qi). Day and night, Qi circulates fifty cycles, measuring 100 clepsydra drops, totaling 13,500 breaths. Communication implies parallel movement of one number; thus, fifty cycles prepare one to enjoy the lifespan of heaven and earth. Now, the patient went from joy to suffering, both damaging Jing Qi. Exhaustion of Jing Qi destroys the form. Sudden joy damages Yang, sudden anger damages Yin, inability to regulate emotions. Heart is the monarch, issuing Shen Ming (Spirit); Lung is the minister, managing Ying and Wei, providing regulation. Greed for desires obscures Heavenly Principle, causing the twelve organs to lose their functions, pathways blocked. Consequently, Jingying Qi departs, unable to irrigate the body, hundred vessels lose their natural measure, form is severely damaged. Using this for health preservation brings disaster; what doubt remains?"

Fire-clearing injures Stomach: Jingli Jin Caiqing consumed rich foods and drinks, developing epistaxis (nosebleed) in spring. The doctor said: "All bleeding indicates heat; administer Qingliang Yin Zi (Cooling Drink) to stop it." Days later, relapse. Doctor said: "Medicine was insufficient for the disease." Prescribed Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxins). Intermittently stopped and relapsed. Changed doctors several times, all using bitter-cold agents to overcome heat, yet never cured. Diet and lifestyle deteriorated compared to initial state; muscles cold with occasional restlessness, voice lost, foul breath like cold wind, though epistaxis waves continued. Someone asked: "Bleeding indicates heat; cooling heat is logical. Why no cure and worsening?" I said: "The Neijing states: 'The five Zang aim for balance.' Also: 'Inferior doctors exhaust Qi; one must be cautious.' They only see bleeding as heat and attack with bitter-cold, ignoring that bitter-cold drains Spleen and Stomach. Spleen and Stomach are Earth, the foundation of the body. Now, fire pathology attacks Earth; fire may not be removed, but Earth is diseased. Earth disease causes Stomach deficiency; Stomach deficiency prevents Ying Qi from nourishing vessels; Yuan Qi fails to follow natural measures; Qi transforms with Yin, losing voice and warming muscles. Alas, crude doctors laugh, thinking it curable. Heat persists, cold disease arises anew; this is what is meant."

Inferior doctors exhaust Qi endangering life: In Ding Si year, summer, visiting Kaizhou, Qianhu Gao Guoyong told me: "My father, 73 years old, last July, suffered dietary injury and rainy weather, causing acute diarrhea/dysentery. Doctors stopped it with medicine. Not long after, re-injury and diarrhea; stop then re-injure, injure then purge. By October, emaciated, limbs fatigued, reduced diet, abdominal pain, borborygmus. Doctor Li prescribed Yangzang Tang (Nourish Viscera Decoction); after days, diarrhea stopped, but vomiting began. Doctor Wang used Dingxiang (Clove), Renshen (Ginseng), Huoxiang (Patchouli), Juhong (Tangerine Peel), Gancao (Licorice) as powder, decocted with ginger; vomiting stopped after several doses. By January this year, no intake, needs support to rise. No bowel movement for days. I asked the doctor: 'Father has no bowel movement; how to treat?' Doctor said: 'Old gentleman over seventy, Qi and Blood weak, half-year diarrhea/dysentery, Spleen/Stomach long deficient, fluids depleted. Maziren Wan (Hemp Seed Pill) for moistening is suitable.' Relatives discussed; one suggested Niu Shanshan from Fengcun for decisive diagnosis. Pulse taken, illness asked: 'This is Wind Knot. Take over 100 pills of Soufeng Wan (Wind-Searching Pill). Died after several loose stools. I regret endlessly; may I ask?' I said: "Humans rely on water and grain as root. Elderly with chronic diarrhea has depleted gastric fluids; heavy purging leaves Shen without basis. The *Ling Shu* states: 'Form/Qi insufficient, Pathogen Qi insufficient; this is dual insufficiency of Yin/Yang. Do not purge. Purging increases insufficiency; dual insufficiency leads to exhaustion of Yin/Yang, depletion of Blood/Qi, emptiness of five Zang, withering of sinews/marrow/bone. Elderly perish, young do not recover.' Also: 'Superior doctors regulate Qi, middle disrupt pulses, inferior exhaust Qi endangering life.' Exhausting Qi endangering life refers to Dr. Niu.

Medication without basis becomes thief of Qi: Li Zhongkuan, Beijing surveillance clerk, 50 years old, spring of Ji Si year in Yuan dynasty, suffered wind syndrome: hemiplegia, numbness, slurred speech, mental confusion. A friend prescribed: 0.5 jin Dahuang (Rhubarb), 3 sheng Heidou (Black Soybean), 1 dou water, boil until beans cooked, remove rhubarb, rinse with fresh water, take 2-3 he per day. Wind-heat would depart. Taken halfway, another friend advised combining Tongsheng San, Siwu Tang (Four Substances Decoction), and Huanglian Jiedu Tang for faster effect. Taken for over a month, spirit increasingly fatigued. Returned to Zhengding, home for recovery. Relatives/friends offered countless prescriptions, not fully recorded. Added aphonia, cold Qi, cold hands/feet. Asked me to examine. Detailed inquiry into history. Pulse: six pulses fine as spider silk. I said: "Diseases vary in exterior/interior, deficiency/excess, cold/heat. Medicines have sovereign/minister/assistant/courier roles, sizes, odd/even formulations. Your medications lack basis, hence disease worsens. Now incurable; you brought this upon yourself." Died shortly after. Xiao Shi, wife of Official Cao Tongfu, over 60, poor and isolated, suddenly suffered wind disease in spring: hemiplegia, slurred speech, confusion, facial deviation, same as Li. I punctured Jing-Well points of twelve meridians to connect collaterals, ineffective. Moxibustioned Jianjing (GB21) and Quchi (LI11). Analyzed disease timing/month for medication, halved dosage. I said: "No need for medicine; disease will self-heal." Next spring, saw her walking normally at Langzhong Zhang Zijing's home. I sighed: "Recovery due to不乱服药 (not taking random medicines). Thus, Li Zhongkuan's random medication was incurable. Xiao's poverty allowed tranquility. Neijing states: 'Medication without basis becomes thief of Qi; sages warn against it.' One day, Yao Xuezai quoted Mr. Xu: 'Rich/Noble have two things worse than poor/humble: inability to correct faults, inability to treat illness.' Alas, referring to Li.

Warning against reckless purging: Li Tijuzheng, Zhengding Mint Officer, over 40, robust and fleshy. Colleague Shi Jun warned: "Fat people often suffer wind syndromes. You risk stroke. Soufeng Wan pushes out old, generates new, resolves phlegm; suitable for you." Li agreed, prepared one dose, daily intake. Nightly five bowel movements. Half month later, shortness of breath. Month later, lethargy, drowsiness, white pus in stool, urinary incontinence, coldness from feet to knees, heavy/sore back, tastelessness, anorexia, epigastric fullness, intermittent restlessness, forgetfulness, anxiety. Three doctors changed, ineffective. Explained history, requested treatment. I said: "Sun Simiao stated: 'Medicinal forces have bias, disturbing Zang Qi equilibrium. Medicine attacks disease; without disease, do not ingest. Healthy person: grain enters stomach, pulses flow; water enters channels, blood forms. Water gone, Ying scatters; grain digested, Wei perishes. Ying scattered, Wei perished, Shen has no basis. You are healthy, Zang stable. Recklessly using mildly toxic purgatives daily causes multiple stools. First day pushes out old. Old gone, what to push? Now food does not build flesh, water/grain fail to transform essence, irrigate Zang/Fu/vessels. Where is Shen based? Shortness of breath = True Qi damage. Lethargy = Spleen Qi decline. Incontinence = Bladder fails to store. Pus/blood in stool = Stomach Qi sinking. Cold calves = Yang Qi weak. Restlessness/epigastric empty fullness = Stomach Qi fails to ascend. Forgetfulness/confusion = Shen disorder.' Jingui states: 'Purging when unnecessary causes洞泄 and incontinence, leading to death.' These symptoms are not heavenly fate; you brought them upon yourself. Treatment barely stabilized, but shortened life. Li terrified, sweaty back, rose saying: 'Reckless purging error, how to repent! Though, please save me.' I thought disease advanced past halfway, hard to cure, declined and left. Autumn, illness worsened. Doctor used Duoming San (Life-Seizing Powder) to purge. Died of dry heat, wheezing, fullness. Neijing states: 'Punishing the innocent is called great confusion.' Like Mr. Li, the Neijing calls him confused. Gentleman of health, beware!"