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To merely tonify deficiency and to merely clear heat is ultimately vague and misses the key point. However, apart from tonifying deficiency and clearing heat, there are no other methods; one must distinguish them carefully. There are two methods of tonifying deficiency: one is tonifying the Spleen; the other is tonifying the Stomach.
For example, after malaria or dysentery, if Spleen Qi is weak and food cannot be transformed and transported, it is appropriate to tonify the Spleen; for instance, after a Shanghan (Cold Damage) disease, if Stomach fluids have been consumed for a long time and new fluids have not yet generated, it is appropriate to tonify the Stomach. The difference between the two is as vast as heaven and earth. There are also two methods of clearing heat: heat at the onset of illness is Excess Heat, which should be cleared with Bitter-Cold herbs; heat appearing after the illness is Deficiency Heat, which should be cleared with Sweet-Cold herbs. The difference between these two is also as vast as heaven and earth. The innate vital Qi of the human body resides entirely in the Stomach Qi (appetite/digestive function). Insufficiency of fluids constitutes deficiency; generating fluids constitutes tonifying deficiency. Therefore, combining herbs that generate fluids with those that clear heat using Sweet-Cold properties to treat post-infection deficiency heat, such as Ophiopogonis Radix (Maidong), Rehmanniae Radix Preparata (Shudihuang), Moutan Cortex (Danpi), Ginseng Radix et Rhizoma (Renshen), and Pear Juice, are all lawful treatments. If one mistakenly administers herbs like Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), and Atractylodis Rhizoma (Baizhu) for tonifying the Spleen as a form of tonification, would this not amount to tonifying both the pathogenic heat and the deficiency? As for dietary tonification, one should only utilize its Qi (energetic quality), not its Flavor (taste/substance). For example, nourish it with the Qi of the five grains, and fill it with the Qi of the five vegetables. People generally do not understand this principle; they are eager to use rich, greasy, and sweet flavors to tonify, unaware that grease and oil obstruct the meridians, preventing pathogenic heat from exiting outward. (Yu Jiayan)

Selected Cases
The eldest son of Mr. Xu Wuyi suffered from severe Shanghan (Cold Damage). Someone reported that the patient fainted and fell into unconsciousness early in the morning upon rising. I asked, "How many days has he been ill?" He replied, "Nine days." I asked, "Is his chest still warm?" He answered, "It is just not cold." I said, "He can be saved." Upon arrival, I found him lying stiffly in bed, without breath at the mouth and nose, with a cyan face, clenched jaw, closed eyes, and relaxed hands. His lips were purple-black. I smiled and said, "This person will not die. This is due to the mistaken administration of Baihu Tang (White Tiger Decoction) in a Yin-Deficiency pattern." I palpated the pulse; the Chi (Cun-Kou) pulses at both wrists were still present. I then took one liang of Ginseng Radix et Rhizoma (Renshen) and two liang of Rehmanniae Radix Preparata (Shudihuang), along with three qian each of Aconiti Lateralis Radix Preparata (Fuzi) and Zingiberis Radix Preparata (Paojiang), decocted them strongly, pried open his mouth, and administered the liquid. After finishing the dose, his eyes opened, his complexion turned red, and within less than an hour, he cried out loudly about feeling extremely cold, followed by a high fever. He sweated profusely over his entire body and regained consciousness. That evening, his abdomen was distended and he had no bowel movement. I said, "Do not worry; after profuse sweating, the deficient Zheng Qi (Upright Qi) lacks the strength to expel stool. Drinking more medicine will facilitate passage." The next day, all symptoms disappeared, except for delirious speech and angry cursing, as if possessed by spirits. He was treated with Fuzi Lizhong Wan (Aconite and Ginger Regulate the Middle Pill) and Xiaojianzhong Tang (Minor Construct the Middle Decoction) until he recovered. (from *Jiren Bian*)

Fang Yugong suffered from Shanghan (Cold Damage) for nine days, presenting with headache, floating pulse, and a body hot as burning charcoal. Many diaphoretic prescriptions were given, but sweat never occurred. I said, "Although Shanghan (Cold Damage) should indeed be treated with diaphoresis, acrid-dispersing herbs assist heat and consume Yin. When sweat is blocked by heat, it cannot reach the exterior. One must nourish the fluids so that Yin and Yang harmonize, allowing rain (sweat) to descend." The trial proved correct. (Cheng Huazhong)

A woman suffered from Shanghan (Cold Damage) for more than ten days, exhibiting restless limbs, twitching of the mouth and eyes, pale complexion, cold body, delirium, and mania. Her family thought it was madness and bound her limbs. Some considered it a Deficiency syndrome, others a Cold syndrome, and some refused treatment. Her pulse was imperceptible; she did not respond to questions regarding her symptoms; her body was not hot to touch. I said, "This is either a Renshen-Fuzi (Ginseng-Aconite) case or a Xiaoshi-Dahuang (Niter-Rhubarb) case. Choosing one way or the other determines life or death immediately." I sat observing for a long time, hearing her voice was heavy and long. Reflecting carefully, if this were a Deficiency-Cold syndrome, at the stage of pulse collapse, with faint breathing, how could she have enough strength to shout loudly? I therefore prepared Dachengqi Tang (Major Order the Yellow Decoction). With her jaw tightly clenched, I pried it open and forced the decoction down. At dusk, she passed black stool. By early morning, her pulse returned, she had a fever, and her mental state clarified. She took two doses of XiaoXiantong Tang (Small Trap-Piercing Decoction) and recovered.
○ Xiang Xunru, a Licentiatus, suffered from Shanghan (Cold Damage). After taking two doses of diaphoretic herbs, his condition worsened significantly: he became comatose with fever, and his pulse became faint and nearly absent. Urgently, I prescribed one liang each of Ginseng Radix et Rhizoma (Renshen), Atractylodis Rhizoma (Baizhu), and Poria (Fuling), three qian of Aconiti Lateralis Radix Preparata (Fuzi), and two qian each of Zingiberis Rhizoma (Shengjiang) and Cinnamomi Ramulus (Guizhi). In the afternoon, his pulse gradually emerged. Subsequently, six to seven doses were administered, but the condition remained unchanged, worsening with swollen tongue, ulcerated lips, and incessant thirst requiring drinking. I said, "The disease is this disease, the medicine is this medicine; taking it makes things worse. Could there be an error?" Observing no improvement, I advanced several more doses, but the condition persisted. For over ten days, he could not speak. Fortunately, his son believed firmly and knelt begging for rescue. I said, "The medication has reached the limit, yet the disease does not transform. What shall we do?" I switched to Ba Wei Wan (Eight-Ingredient Pill) formula, one jin, decocted strongly into six bowls, and gave it to him cold. He finished it day and night. His tongue reduced in swelling, could extend, and he could speak and recognize people. He took one dose daily and ate several bowls of porridge. Bowel movements did not occur, so I left nature to take its course. On the 28th or 29th day, his abdomen finally distended. I then used a decoction of Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), Paeoniae Radix Alba (Baishao), Atractylodis Rhizoma (Baizhu), Zingiberis Rhizoma (Shengjiang), Cinnamomi Ramulus (Guizhi), and Aconiti Lateralis Radix Preparata (Fuzi), adding two qian of Rheum Palmatum (Dahuang). After ingestion, slight sweat appeared on his forehead, and his limbs became restless. This indicated extreme deficiency of Zheng Qi (Upright Qi). I then administered a large-dose warming-tonic prescription, after which he lay quietly and passed half a bucket of old stool during the night. He later took one hundred doses of warming-tonic medicines and recovered. In total, five jin of Ginseng Radix et Rhizoma (Renshen) and thirty pieces of Aconiti Lateralis Radix Preparata (Fuzi) were used. Any slight lapse in regulation led to fever and mandibular dislocation-like symptoms, until he recovered healthily the following year. (Zhang Xiju)

Huang Changren engaged in sexual activity while suffering from Shanghan (Cold Damage). Adhering to the taboo against taking medicine, his body heat had subsided for over ten days when suddenly he became lethargic and shivering, with icy hands and feet. A physician had already compounded a Shengjiang-Fuzi (Fresh Ginger-Aconite) prescription. Seeing this, I was shocked. After diagnosis, I repeatedly refuted the error. The family suspected a Yin syndrome and would not listen to me. I made an agreement with the physician: "Once this medicine enters the mouth, life and death hang in the balance. You and I will each bear responsibility." The physician said, "I have treated Shanghan (Cold Damage) for thirty years; I know nothing of 'bearing responsibility'." I laughed and said, "With my clear vision here, I cannot bear to see a living person die. If you will not accept responsibility, let me use my medication." I prepared Tiaowei Chengqi Tang (Regulate the Stomach Order the Yellow Decoction), heated it, and administered half a cup. Shortly after, another half cup was given. His extremities warmed, and he regained consciousness. After finishing the previous medicine, his mental state cleared completely, but he developed intense whole-body heat. I then gave one dose of Da Chaihu Tang (Major Bupleurum Decoction), after which the heat subsided and he felt comfortable.
○ Xu Guozhen suffered from Shanghan (Cold Damage) for six or seven days, presenting with body heat, red eyes, desire for water but refusing to drink when brought, extreme restlessness, opening doors and windows wide, and lying on the ground. A physician administered a Chengqi Tang (Order the Yellow Decoction) variant. I palpated his pulse: it was surging and large beyond measure, but empty upon deep pressure. I told him, "This is a Renshen-Fuzi-Ganjiang (Ginseng-Aconite-Dried Ginger) case. Why do you consider it a purgation case?" The physician said, "With body heat, red eyes, and such extreme agitation, administering Renshen, Fuzi, and Ganjiang would make him jump walls and climb roofs." I said, "Yang Qi is about to violently collapse; false heat appears externally while true cold exists internally. Even Jiang (Ginger) and Fu (Aconite) may barely suffice to restore Yang; how dare one use purely Yin-cold herbs to heavily plunder his Yang? Observe that he does not wish to swallow water; the truth is revealed. If he does not even wish to swallow water, how could he swallow Niter (Xiaoshi) and Rhubarb (Dahuang)? When the weather is sultry and steaming, heavy rain must follow. Suddenly, profuse sweating over the entire body will occur, and it will be incurable. Only by using Jiang and Fu, which embody 'tonification with dispersion,' can one achieve two goals with one stroke. Why doubt this?" Thus, I prescribed five qian each of Aconiti Lateralis Radix Preparata (Fuzi) and Zingiberis Rhizoma (Ganjiang), three qian of Ginseng Radix et Rhizoma (Renshen), and two qian of Glycyrrhizae Radix et Rhizoma (Gancao). The decoction was cooled before administration. After ingestion, he experienced chills and teeth chattering. Covering him with thick cotton, the signs of Yang deficiency became apparent. After two doses, slight sweat occurred, heat subsided, and he stabilized. (Yu Jiayan)