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Yang deficiency makes one susceptible to cold pathogens, while yin deficiency makes one susceptible to heat pathogens. This is because the insufficiency within the body attracts the excess of external pathogens, which follows the principle that "water flows to dampness and fire tends to dryness," and also due to the lack of ability to resist external pathogens. However, there are cases where yin deficiency presents with cold syndromes and yang deficiency presents with heat syndromes; these pathogens are attracted due to weakness and do not necessarily need to be of the same nature to interact. Treating heat requires caution against damaging yang, and treating cold requires worry about damaging yin, making it the most difficult to manage.

Yin deficiency typically manifests only as fever, without aversion to cold, but sometimes aversion to cold occurs; this is because excessive heat may assume the transformation characteristics of the element that controls it (i.e., extreme heat mimicking cold). Qi deficiency typically manifests only as aversion to cold, without fever, but sometimes fever occurs; this is because fire and primordial qi cannot coexist (when fire is strong, primordial qi declines).

Yellow or reddish urine mostly indicates heat syndromes. The classics also state: "When lung qi is deficient, there is pain in the shoulder and back with cold sensation, shortness of breath, and a change in urine color." Also, when the winter pulse is insufficient (weak), it causes coldness in the lower back and spine, and a change in urine color. These two passages discuss how kidney and lung deficiency-cold lead to changes in urine color. Why do deficiency-excess and cold-heat differ so greatly, yet the symptoms are similar? One must understand that lung deficiency fails to regulate water passages, and kidney deficiency fails to control the opening and closing of the gates, both leading to stagnation and generating heat. Heat causes changes in urine color. Thus, although both present with changed urine color, there are differences between deficiency and excess. This is also a method of "following treatment" (treating according to the nature of the disease) that must be known.

Zhang Hanbu said: Among cases of red urine, some are caused by middle-jiao cold, which is common in elderly patients with deficiency constitutions. Regarding changes in urine color, the heat explanation is general and will not be elaborated here.

One must subdue the dominant pathogenic factor and address its cause first.

Erysipelas (Dan Du) and macules (Ban) have different etiologies involving exterior and interior. Erysipelas results from contracting epidemic abnormal qi, which stagnates in the Ying and Wei levels. Macules arise from stasis-heat in the Yangming channel manifesting in the muscles. Although both are suitable for clearing heat, treating erysipelas requires dispersing methods, while treating macules requires considering the patient's deficiency. Macules can also lead to loss of yang on the exterior, as seen in the case treated by Zhu Danxi involving General Wanyan. Additionally, papules that appear and disappear quickly belong to yin deficiency with wandering deficient fire. Itching and hives (Yin Zhen) may be caused by wind-dampness or phlegm.

Wind damages the Wei (Defensive) qi. When Wei qi is damaged, it cannot secure body fluids, leading to spontaneous sweating. This understanding deeply grasps the essence of using Guizhi Tang (Cinnamon Twig Decoction). "Exterior excess leads to interior deficiency" is a phrase often skimmed over without seeking its rationale. Ying and Wei qi derive their energy from the chest, and the zang-fu organs rely on the transport functions of Ying and Wei. Now, if Ying and Wei are affected by pathogens and become excess, they lose their transport function, leading to interior deficiency. This is a shallow aspect of medical theory easily overlooked.

Zhang Yongfu said: "Ying and Wei affected by pathogens and becoming excess" should be stated as "Wei affected by pathogens and becoming excess." In this way, Ying loses the protection of Wei, leading to interior deficiency. Otherwise, the phrase "exterior excess, interior deficiency" remains unclear.

Diseases may seem vastly different but share the same underlying principles. For example, Lung Flaccidity (Fei Wei) differs from Limb Atrophy (Wai Qu), and Lung Abscess (Fei Yong) differs from Bi Syndrome (Bi Bing). However, one is based on yin deficiency and the other on yang excess; their principles are the same. Therefore, scholars must know how to use analogical reasoning.

The three Yang channels guard the exterior, and the three Yin channels guard the interior; originally, there is no superiority or inferiority. However, yang qi likes expansion and dislikes stagnation. Stagnation generates heat, and the seven emotions and six exogenous factors can all cause stagnation. Furthermore, weather generates yang, rich foods assist fire, and fatigue disturbs the harmonious movement of yang, transforming into fire. Thus, fire and heat battle within the body, inevitably injuring yin. When yin is injured, yang becomes hyperactive; when yang is hyperactive, yin is further injured, leading to imbalance and deficiency. Hence, Zhu Danxi proposed the theory of "Yang is often in excess, Yin is often deficient." People who read his words without seeking their true meaning deserve criticism for blind following.

Taiyin and Jueyin channels typically do not present with heat, whereas Shaoyin does. This is because Shaoyin is paired with Taiyang as exterior-interior, and Shaoyin is the "exterior of the interior." Additionally, Shaoyin stores True Yang. These two factors contribute to Shaoyin presenting with heat. This can be inferred from the use of Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction).

Stomach bias towards yang leads to easy digestion and frequent hunger. It is also said: "Pathogenic heat fails to digest food." Digestion refers to the exposure of stomach yang, while failure to digest refers to pathogenic heat.

Did *Shanghan Lun* (Treatise on Cold Damage) and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) record every verified case? No, they merely established principles based on where righteous qi battles pathogenic qi, which channel is involved, and what the manifestations are, discussing the rationale. This is not fabrication. If later generations understand these principles clearly, it is not difficult. These discussions by sages are tools to grasp the essence. *Yaolue* highlights key points; expanding upon them depends on the individual.

Extreme dryness causes lockjaw, fright, and frequent yawning because Wood is imprisoned by Metal and cannot expand. Uterine dryness in women causing sadness shares this meaning.

If cooling measures fail to resolve heat, treat the yin; if warming measures fail to resolve cold, treat the yang. Seek the root affiliation.

When heaven and earth do not interact, yang dominates above without yin to cover it; yin dominates below, filling the origins of the nine orifices. In this case, add astringent and descending agents to yang herbs to return yang to yin, and add ascending and generating agents to yin herbs to allow yin to join yang.

Overuse of yin essences leads to yin collapse below; sudden joy damages yang, leading to yang collapse above. In such cases, tonify yin and yang respectively. If there is loss of yin with yang collapsing above, or loss of yang with yin collapsing below, then for yin collapse, tonify yang; for yang collapse, tonify yin.

For yin deficiency with yang hyperactivity, the method is to nourish water (kidney yin), possibly adding raw Gancao (Licorice Root) to clear fire. This concerns congenital yin and yang. For yin deficiency generating damp-heat, the method is to nourish yin to drain damp-heat, such as Liuwei Wan (Six-Ingredient Pill) plus Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome). This concerns acquired yin and yang. For yin deficiency with yang having no attachment, severely tonify yin to anchor yang; for yang deficiency with no support, severely tonify yang to guide yin; for dual yin-yang deficiency, gently tonify both to restore their positions. This integrates acquired yin-yang with congenital yin-yang.

Xianghuo (Ministerial Fire) has two types: in Shaoyin, it is Yuan Yang (Primordial Yang); in Shaoyang, it is Shengfa Qi (Generating Qi). Both require yin to nourish them. Most coughs are caused by fire overcoming metal, called "robber pathogen," making them hard to cure. While excess fire can be drained, deficient fire requires strengthening the master of water (nourishing kidney yin). However, is strengthening water an easy task for ordinary people? Can it be achieved quickly? Moreover, yin deficiency below leads to phlegm-qiu stagnation above, and yin-nourishing drugs often obstruct qi and retain phlegm, making rapid effects difficult.

Liu Dan'an said: This is a cough due to internal injury yin deficiency, where fire overcomes metal. If wind-cold enters externally and lung pathogens are not resolved, over time fire also overcomes metal, transmitting and generating phlegm. This requires clear recognition.

Some suffer from cold feet at midnight during winter. As yang qi begins to generate, the cold feels worse. This is a mild illness in robust individuals who overexert themselves in autumn and winter. Such people usually have much heat in the upper jiao. Because the two kidneys embrace yin and yang, losing one part of yin releases one part of yang. After strenuous sexual activity, depleting the storage function, even if yin essence is not fully depleted, yang qi cannot be fully stored. Thus, the upper jiao often has heat, and the lower jiao often has cold. During autumn and winter, when yin qi is abundant and yang qi is scarce, the feet become cold. During the day, when yang qi is strong, it may enter yin. But after midnight, the newly generated yang qi is weak and cannot enter yin, making the feet colder. This is similar to summer solstice, where one yin is born but the weather is hot, and winter solstice, where one yang is born but the weather is cold; the principle is the same. Furthermore, the released yang and the newly generated yang in the upper jiao battle in the chest, causing phlegm and qi stagnation. This is another meaning of "yang failing to enter yin." The *Neijing* states in the Cold Jue chapter: "In spring and summer, yang qi is abundant and yin qi is scarce; in autumn and winter, yin qi is prosperous and yang qi declines." This person is robust but overexerts in autumn and winter. Lower qi struggles upward and cannot recover; essence overflows downward, and pathogenic qi follows upward. People know that overexertion in autumn and winter depletes the storage function, but do not know what is being stored. Storage refers to this yang qi. When yang qi reaches this time, it stores in the kidney, and one should plan for cultivation for next year's growth. How can one rely on robust constitution and engage in sex, thereby depleting this storage function? Thus, lower jiao yang declines. Declining, it seeks help from upper jiao yang. Originally relying on lower jiao yang as its root, now that hidden lower jiao yang is weak, how can upper jiao yang recover? Yang cannot hold yin essence, causing essence to overflow downward. Upper and lower yang are both deficient. Seasonal cold combines with lower jiao cold and rises upward, causing Cold Jue. Later commentators say "overexertion" means essence depletion below, with upper struggle seeking help from mother qi, kidney loss too great, lung generation insufficient, hence inability to recover. Such statements imply that yin deficiency syndromes should not present as Cold Jue, contradicting the principle that yang decline below causes Cold Jue and yang decline failing to nourish meridians. This error stems from literal interpretation, leaving students confused.

Kidney deficiency leading to water overflowing as phlegm refers to kidney yang deficiency; thus, water overflows. If yin deficiency, there is rising without descending, causing coughing up of saliva and phlegm. These two are vastly different, with distinct treatments.

Fire sinking and hiding mostly stems from yin deficiency, lacking the ability to contain it. The classics state: "When yin pulses are insufficient, yang attacks." Thus, nourishing one part of yin can expel one part of fire. For example, in malaria with weak pathogens and recovering righteousness, ulcers may appear on the mouth and tongue. Similarly, thirst in cold damage indicates recovery.

Zhu Danxi's theory of yin insufficiency is precise, implying yin should be nourished. However, Daoism speaks of pure yang, preferring yang and disliking yin. One must know that yin and yang cannot dominate excessively nor be neglected. Their seamless interaction is True Qi (Primordial Qi), i.e., Life Qi. Human movement and vitality rely on this yang qi, but nourishing it relies entirely on yin qi, like fish needing water. Thus, "yin inside is the guardian of yang." If yin qi lacks one part, yang qi escapes one part. If yin qi is completely exhausted, lone yang flies away. Those good at self-care avoid external pathogens and internal emotional disturbance, eat blandly, keep fire distant so yin remains complete. With complete yin, yang embraces it, filling limbs and bones with yang qi, hence called "pure yang." Ignoring this and solely nourishing yang for longevity contradicts the classic: "Having yang without yin is called Jue Yang." Can Jue Yang survive?

Regarding malaria chills and fever, distinguish three causes: 1. Accumulation of tangible matter in the middle jiao. Middle jiao qi governs Ying and Wei circulation. Obstruction by tangible matter causes Ying and Wei to lack qi and become deficient. Wei deficiency causes aversion to cold; Ying deficiency causes fever. 2. Summerheat pathogen constrained by yin-cold between exterior and interior. Upon activation, attacking yin makes yin excess and yang tyrannical; attacking yang makes yang excess and yin deficient. YIN deficiency causes fever; yang deficiency causes aversion to cold. 3. Exhaustion of both qi and blood. Qi deficiency causes aversion to cold; blood deficiency causes fever. All chills and fevers fall into these three categories.

Zhang Hanbu said: The explanation of qi and blood deficiency causing chills and fever in malaria should be distinguished. Qi insufficiency causes middle jiao qi to intermittently stop flowing, condensing into distension and fullness. Blood insufficiency fails to absorb yang qi from below, causing middle jiao qi to intermittently stop flowing, condensing into distension and fullness. One should diagnose pulse and symptoms, observe yin/yang deficiency, and tonify accordingly. All qi-breaking and digestion-promoting drugs are contraindicated. Limbs and bones receive qi from the chest. Qi and blood deficiency causes generalized edema, similar to middle jiao qi stagnation causing distension. Here, assess qi/blood deficiency and tonify; edema will subside. All diuretic and swelling-reducing drugs are contraindicated.

Clearly knowing reversal and normalcy allows uninterrupted practice.

Persistent vomiting and epistaxis may require purgation. People know bleeding from lower orifices is favorable, so this method applies to rebellious bleeding. However, rebellious bleeding is caused by fire. Treating fire requires bitter-cold herbs, which congeal blood. Congealed blood stops flowing, preventing qi rebellion and stopping vomiting. Even if bleeding stops, blood stasis complications arise. Thus, using bitter-cold purgatives lowers fire and prevents stasis, achieving two goals at once.

Liu Dan'an said: Using bitter-cold purgatives for vomiting/epistaxis removes blood stasis. However, it is better to use bitter-cold cautiously to avoid blood stasis rather than purging.

Tracing back to yin and yang.

Exterior yang attaches to body fluids. Profuse sweating loses fluids, hence called "loss of yang." Interior yang attaches to kidney water. Sexual exhaustion damages yin essence, hence called "collapse of yang." Otherwise, since fluids and essence are yin categories, why name them yang?

Warm Malaria and Wind-Warmth all occur in people who did not store essence in winter. Cold directly strikes Shaoyin, and in spring, warmth triggers disease. Though severity varies, the cause is the same. *Neijing* and Zhang Zhongjing did not detail treatments, only theories. Later generations approximated treatments based on theory, generally using sweet-cold to save kidney and acrid-cool to dispel warmth. Did they not consider that kidney deficiency involves both yuan yin and yuan yang deficiency? This method works for yin deficiency but not yang deficiency. Knowing winter non-storage is yin deficiency, one must ask: if yin is deficient, can yang remain stable? Moreover, the single True Yang in the kidneys is the "God guarding against pathogens." True wind-cold striking Shaoyin often occurs because this God fails to guard. Can such cases be treated with previous methods? How can we revive Zhang Zhongjing to discuss the ultimate truth?

Elderly people are yin deficient 80-90% of the time, and yang deficient only 1-2%. This aligns with natural laws. Ancients were honest and peaceful (yin nature); modern people are sharp and irritable (yang nature). The decline of society reflects the decline of this honest, peaceful yin qi. Understanding this, ancient formulas may not fit modern diseases. Discussions on advancing yang/retracting yin or advancing gentlemen/retracting villains, like the I Ching favoring Fu (Return) and disliking Bo (Peeling), refer to generating vs. destructive qi, not daily physiological yin-yang fluctuation.

Liu Dan'an said: Elderly people are indeed yin deficient, but more so. Some take Ginseng, Astragalus, Aconite, and Cinnamon but cannot endure them, only surviving long-term by doing so. Why? This view should be flexible, not rigid.

Chills and fever are simply yin and yang in the body. Harmonized, they are yin and yang; discordant, they are chills and fever.

Wei belongs to yang; its qi is fierce, so it moves fast. Ying belongs to yin; its qi is quiet, so it moves slow. Malaria pathogens affecting Ying cause intermittent or consecutive day发作. The pathogen adheres to Ying. In a celestial cycle, the sun passes it, the moon falls behind. This is also a division of yin-yang speed.

What generates me is the Five Movements Qi; what destroys me is also the Five Movements Qi. Thus, the five zang organs embody the five elements. When pathogens gather, whether due to original qi deficiency or attack from other zang organs, each presents its image as disease. In terms of pulse, if true zang pulses appear, death can be predicted.

Moxibustion on needles benefits yang but damages yin. Currently, yin qi is declining, transforming into fire. Thus, needle moxibustion is often ineffective. Not because the transmission is lost, but because times have changed. Even if Qibo were born today, he would abandon needle moxibustion for herbal decoctions. Treating disease superficially is treating symptoms only. Treating deeply is punishing the innocent (pathogens without addressing root). Tracing back to yin and yang ensures success.

Dietary care completes treatment; do not exceed limits, lest it damage righteous qi.

Wiry and rapid pulses indicate wind onset. Using dietary adjustments to stop it deeply understands the principle of avoiding medication.

When spirit and qi are harmonious, the mechanism of life continues. Thus, health cultivators cannot be inactive but must not force action. This is the principle of heaven and earth forming transformations without intent, and sages acting with intent but without forcing. Ignorant people are controlled by desires, causing disease. Good fortune, misfortune, regret, and shame arise from movement. How can this be treated with acupuncture or herbs? Self-reflection and nurturing are sufficient.

Know that pathogenic qi is essentially righteous qi within us. Treated, it becomes righteous qi; untreated, it becomes pathogenic qi. Only then do we understand that "nourishing righteousness eliminates accumulation" is not false.

Not clarifying the source but wanting clear flow, removing fuel but wanting boiling to stop, cutting rich food but expecting accumulation to dissolve—these are impossible.

At the beginning of disease, acupuncture suffices. When severe, wait for decline. Reading text without understanding meaning, or knowing meaning without detailed methods, leads to failed treatment. Let us discuss. Disease begins with loss of true qi defense, allowing pathogens to invade. Pathogens include internal injury and external contraction. Initially, it is a guest disease; attacking it to remove it is fine, hence "acupuncture suffices." Over time, righteous qi becomes deficient, generating pathogenic heat. Neither tonification nor attack is suitable. Prudent practitioners should advise careful living to increase yin essence daily. As heat retreats, residual pathogens fade. This is "non-treatment as treatment," hence "wait for decline." Showing patients and doctors the principle and method of waiting is crucial. Impatience leads to seeking quick cures; random medication leads to death not from disease but from doctors.

Poor people with severe illnesses often heal without medicine because they lack the strength to take medicine and the taste to treat pathogens. Doctors treat disease like war, clearing fields for miles, taking large doses of medicine. I disagree. The key is cutting rich food, depriving pathogens of support so they retreat naturally. This is the method of defeating enemies without fighting.

Danxi's theory of eating blandly best fits regulation. However, yin is generated from the five flavors. Eating only blandly may prevent yin generation. I suggest sweet and fatty foods should be boiled blandly to prevent phlegm and fire. Vegetables can have salt and fermented bean added to enhance flavor.

Zhang Hanbu said: "For insufficiency of essence, tonify with flavor." Cutting rich food depends on the disease and contraindications. For example, edema worsens with salt. Teaching everyone to eat blandly may exhaust stomach qi and spirit irrecoverably. Boiling rich foods blandly is appropriate.

Subtlety lies in the pulse; it must not be ignored.

*Neijing* states: "Blood deficiency leads to large pulse." However, qi deficiency can also lead to large pulse. Blood deficiency leaves qi unattached, causing large pulse; qi deficiency allows pathogenic fire to flourish, also causing large pulse. These principles exist in classics but are not explicitly pointed out, leading to confusion in this field.

Small and thin pulses indicate righteous qi deficiency; surging and large pulses indicate pathogenic qi excess. Righteous qi deficiency with small/thin pulse can be cured by tonification; pathogenic qi excess with surging/large pulse can be cured by draining. However, righteous qi deficiency with surging/large pulse, or pathogenic qi excess with small/thin pulse, indicate either righteous deficiency with pathogenic victory or pathogenic victory with righteous deficiency, both untreatable. Diagnosticians must know this general idea to solve problems easily. Ask about disease then examine pulse; match disease with pulse. If pulse matches, disease is identified. If seeking disease from pulse alone, the twenty-four pulses each have complex cold/heat/deficiency/excess patterns, making it impossible to clarify with one touch. For example, floating pulse: floating with force indicates wind; floating without force seems like deficiency. But wind-stroke pulse is floating and slow. What is the difference between slow and without force? Sunken pulse: sunken with force indicates excess; sunken without force seems like deficiency. But cold invasion pulse is sunken, minute, and thin. What is the difference between minute/thin and without force? Wiry pulse: Shaoyang pathogen causes wiry pulse; blood deficiency causes wiry pulse; wind patients have wiry pulse; fluid retention causes wiry pulse. Without asking about robustness, exterior-interior, yin-yang, and suffering, how can holding the cun-kou pulse identify disease? Moreover, silencing breathing and hiding behind curtains distresses the doctor and invites blame. Pulses like a chariot canopy or fat floating on soup indicate impending yang collapse. Pulses like a leaking roof or dripping paint indicate impending yin collapse. This follows the principle that things originating from heaven tend upward, and things from earth tend downward.