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In prescribing medications, one must be flexible and adaptable, avoiding rigidity. Consider Zhang Zhongjing's use of Mahuang Tang (Ephedra Decoction) to treat Shaohang disease (Cold Damage) of the Taiyang channel characterized by fever, headache, floating pulse, and anhidrosis; yet it is also used for Yangming disease presenting with a floating pulse, anhidrosis, and wheezing; and for combined diseases of Taiyang and Yangming presenting with wheezing and chest fullness. This illustrates the adaptability of Mahuang Tang. Similarly, Guizhi Tang (Cinnamon Twig Decoction), originally intended for Wind-strike of the Taiyang channel with fever and sweating, is also used for Yangming disease resembling malaria with afternoon tidal fever and a floating-deficient pulse requiring diaphoresis; for Taiyang disease where exterior symptoms remain unresolved with a floating-weak pulse requiring diaphoresis; for Taiyin disease with a floating pulse suitable for diaphoresis; and for Jueyin disease with diarrhea, abdominal fullness, and body pain requiring exterior attack. This illustrates the adaptability of Guizhi Tang. Likewise, Xiaochaihu Tang (Minor Bupleurum Decoction), originally for Shaoyang channel Cold Damage with hypochondriac pain, dry retching, and alternating chills and fever, is also used for Yangming disease with tidal fever and chest-hypochondriac fullness; for Yangming Wind-strike with wiry-floating-large pulse, abdominal fullness, hypochondriac pain, inability to sweat, generalized jaundice, and tidal fever; and for women with Wind-strike who develop persistent chills and fever after menstruation ceases, indicating Heat entering the Blood Chamber resembling malaria. This illustrates the adaptability of Xiaochaihu Tang. From this, we see that Zhang Zhongjing never rigidly adhered to specific formulas for specific channels. The intent behind his prescriptions often transcends verbal description, reflecting a divine principle that cannot be fully conveyed by words. Thus, having a method does not guarantee a corresponding syndrome; having a syndrome does not guarantee a corresponding formula. Even if Zhang Zhongjing were reborn, attempting to strictly follow his established methods, I know they would not always fit. Even if he spoke again, attempting to completely discard his new formulas, I know there would still be merits and flaws. Alas! How can formulas exhaust all variations? How can variations be confined to fixed formulas? If practitioners can grasp the spirit of Zhang Zhongjing, they become Zhang Zhongjing of their own time, and why should they be bound by his formulas? Therefore, I say: Prescribing requires flexibility and adaptation, not rigidity. However, these two words "adaptability" are set for those who cannot adapt. Yet, the principles of this art have their own unchanging essentials. If one ignores these essentials and uses "adaptability" as a pretext for speculation, it leads to reckless deviation from the correct path, misinterpreting classics and expediency, thereby losing the true meaning of adaptability.

Tonifying Formulas are designed to tonify deficiency. For Qi deficiency, tonification should target the upper jiao, using herbs like Renshen (Ginseng Root) and Huangqi (Astragalus Root). For Essence deficiency, tonification should target the lower jiao, using herbs like Shudihuang (Prepared Rehmannia Root) and Gouqizi (Goji Berry). For Yang deficiency, tonification should include warming agents like Rougui (Cinnamon Bark), Fuzi (Prepared Aconite Lateral Root), and Ganjiang (Dried Ginger). For Yin deficiency, tonification should include clearing and moistening agents like Maidong (Ophiopogon Root), Shaoyao (Peony Root), and Shengdihuang (Fresh Rehmannia Root). This distinguishes Yin and Yang treatments. If Qi deficiency stems from Essence deficiency, one must tonify Essence to generate Qi; if Essence deficiency stems from Qi deficiency, one must tonify Qi to generate Essence. If Yang loses its Yin anchor and scatters, how can scattered Qi be gathered without tonifying Yin? If Water fails due to lack of Fire warmth, how can dying Yin revive without tonifying Fire? This is the subtle application of mutual assistance between Yin and Yang. Thus, those skilled in tonifying Yang must seek Yang within Yin tonification, so Yang receives Yin support and generation becomes endless. Those skilled in tonifying Yin must seek Yin within Yang tonification, so Yin receives Yang ascent and sources remain inexhaustible. Therefore, I say: Dividing Yin and Yang by Qi and Essence means they cannot be separated; dividing them by Cold and Heat means they cannot be confused. This addresses the separation and union of pathogens and healthy Qi. Thus, for Yang deficiency with much Cold, sweet-warm tonics are appropriate, while cooling-moistening agents are unsuitable. For Yin deficiency with much Heat, sweet-cool tonics are appropriate, while acrid-dry agents are contraindicated.

Harmonizing Formulas are designed to harmonize disharmony. For diseases with deficiency, harmonize by tonifying; with stagnation, harmonize by moving; with Cold, harmonize by warming; with Heat, harmonize by cooling. The concept of "Harmonizing" is broad, akin to Earth accommodating all four natures, covering tonification, purging, warming, and cooling, aiming to balance Yuan Qi and maintain the Golden Mean. Thus, for lower Yin deficiency with Essence-Blood loss, avoid diuretics; for upper Yin deficiency with Lung Heat dry cough, avoid acrid-dry agents; for upper Yang deficiency, avoid agents that consume Qi; for lower Yang deficiency, avoid sinking-cold agents; for loose stools, avoid slippery agents; for unresolved exterior pathogens, avoid astringents; for Qi stagnation, avoid obstructive agents; for menstrual stasis, avoid cold-congealing agents. For pathogenic Fire in the upper jiao, avoid ascending agents, as Fire will flare up; for Sinking-Cold in the lower jiao, avoid descending agents, as Yin will further deplete. For conditions involving movement, avoid further agitation: for Fire agitation, avoid warming; for Blood agitation, avoid acrid-aromatics; for Sweat agitation, avoid dispersing; for Spirit agitation, avoid consuming agents. All agents with unstable natures/flavors require caution. Those more violent are self-evidently dangerous. For conditions involving stillness, avoid further stillness: such as deep-thin-slow-weak pulses (Stillness of Pulse), confusion and cowardice (Stillness of Yang), cold body surface (Stillness of Exterior), and aversion to cold in mouth/abdomen (Stillness of Interior). All Yin-soft agents require caution. Those with severe sinking-cold are self-evidently dangerous. Yang governs movement; assisting movement with movement is adding oil to fire—will it not burn? Yin governs stillness; assisting stillness with stillness is adding frost to snow—will it not perish? Without understanding this, how can one speak of Harmonizing Formulas?

Attacking Formulas are designed to attack excess. To attack Qi, attack its aggregation, which can be dispersed. To attack Blood, attack its stasis, which can be unblocked. To attack hardness, break or tonify Zang organs, or use acupuncture/moxibustion on meridians. To attack Phlegm, address urgency: acute excess cases may need temporary symptom relief, while deficient cases need root treatment. Excess varies in severity; attacking methods vary in intensity. For severe excess, insufficient attack can be increased; for mild excess, excessive attack causes harm. Do not attack Yin when disease is in Yang; do not attack Zang when disease is in Fu. Otherwise, pathogens enter void spaces, inviting thieves indoors. Do not attack Yang when disease is in Yin; do not attack Exterior when disease is in Interior. Otherwise, illness worsens due to error, removing one's own defenses. Attacking is suitable only for severe pathogens. If excess is genuine, attacking drugs are suitable without mixing tonics, as excess tolerates attack but resists cloying tonics. Deficiency tolerates tonification but resists draining agents. Cold-excess dislikes clearing; Heat-excess dislikes warming. Misusing tonics for excess merely increases illness, which can be resolved; misusing attacking for deficiency depletes Yuan Qi, which is incurable. For mixed deficiency-excess, weigh options carefully, beyond simple immediate attack or tonification. Attacking removes凶暴 (violence) but inevitably damages Qi; benefits are 40%, damage is 60%. Thus, ancient benevolent physicians feared this method due to difficulty in success and ease of failure.

Dispersing Formulas are designed to resolve exterior syndromes. Zhang Zhongjing used Mahuang Tang for Taiyang, Ge Gen Tang (Pueraria Decoction) for Yangming, and Xiaochaihu Tang for Shaoyang. This is the standard for dispersing exterior. Later generations followed but failed to apply correctly due to misunderstanding. Mahuang has fierce, penetrating power, necessary for deep-seated Cold-Damp in Taiyang exterior. It is not exclusive to Taiyang; using it for Yangming/Shaoyang disperses Cold but risks damaging Qi due to excessive strength. Ge Gen acts on Taiyang/Shaoyang; Chaihu (Bupleurum Root) enters Taiyang/Yangming. When using dispersing methods, distinguish speed of action and temperature/nature. Mahuang/Guizhi are fierce dispersants; Jingjie (Schizonepeta), Fangfeng (Saposhnikovia), Zisu (Perilla Leaf) are mild; Xinyi (Magnolia Bud), Baizhi (Dahurian Angelica), Shengjiang (Fresh Ginger) are warm; Chaihu, Ge Gen, Bohe (Mint) are cool; Qianghuo (Notopterygium), Cangzhu (Atractylodes) disperse dampness via meridians; Shengma (Cimicifuga), Chuanxiong (Ligusticum) raise sinking and disperse. Avoid fierce agents for shallow pathogens; avoid strong agents for weak Qi; avoid warm-dry for much Heat; avoid cool for much Cold. Ge Gen suits heat-thirst but harms vomiting; Chaihu suits alternating chills/fever but harms diarrhea; Shengma/Chuanxiong suit upper Cold but harm internal Fire rising. Pairings matter: mild + cool = cool dispersion; mild + warm = warm meridian. Great warmth needs heat-assisting heat; great coolness needs cold-assisting cold. Flexibility allows infinite variation, avoiding rigid adherence.

Cold Formulas are designed to clear Fire and remove Heat. Fire has Yin/Yang; Heat divides into Upper/Lower. Books state Huanglian (Coptis) clears Heart, Huangqin (Scutellaria) clears Lung, Shihu (Dendrobium)/Shaoyao clear Spleen, Longdan (Gentian) clears Liver, Huangbai (Phellodendron) clears Kidney. This is rigid thinking. All cooling herbs drain Fire; distinction lies in light/heavy nature and potency. Light/clear clears Upper; heavy/turbid clears Lower. Strong potency clears major Heat; mild potency clears minor Heat. Used as attack for stagnant Heat; used as drainage for retention Heat; used as tonification for Yin-deficiency dryness. Severe Fire in Upper may need heavy agents; minor Fire in Lower may need light agents. Suitable cooling treats Excess Heat. Excess Heat in Lower needs clearing/drainage; Excess Heat in Upper must not be ascended. Fire is Yang, treated via Yin (descending); ascending makes it Yang. The Classic says: "Suppress what is high." Li Dongyuan's "Ascending Yang to Disperse Fire" applies only to exterior-pathogen generated Heat, not internal latent Fire.

Hot Formulas are designed to remove Cold. Cold invading muscle/skin is external and known. Innate Cold arises invisibly; many suffer it, few know it. Zhu Danxi said: "Excess Qi is Fire." I add: "Deficient Qi is Cold." Few have excess Qi today. Many have deficient Yang due to constitution or depletion, causing internal Cold and various Yang-depletion diseases. Onset is gradual, signs subtle; ignored until severe. Ignorant doctors mistake false Heat for true Fire, killing patients with invisible Cold. Only wise physicians worry about Yang-depletion root, hence knowing Hot Formulas is vital. Using Heat has essentials: Dispersing + Warming dispels Cold pathogens; Moving + Warming moves Cold stagnation; Tonifying + Warming tonifies Deficient Cold. Sweaters avoid Jiang (Ginger) as it disperses; Bleeders avoid Guizhi (Cinnamon Twig) as it moves Blood; Short-of-breath cowards avoid Gubuzi (Psoralea Fruit) as it descends Qi. Aromatic herbs harm Qi deficiency; Acrid herbs harm Blood disorders. Regarding Fuzi (Aconite): used only when desperate. Its function to restore Yang works best when Yang is about to depart, not after it has left. Fuzi is fierce; alone it is hard to manage. Must be paired with Renshen, Shudihuang, Zhigancao (Honey-fried Licorice) to control its harshness and aid its bravery.

Consolidating Formulas are designed to secure leakage. Chronic cough leading to asthma with Qi leaking upward: consolidate Lung. Chronic spermatorrhea leading to strangury with Essence leaking downward: consolidate Kidney. Incontinence of urine: consolidate Bladder. Incontinence of stool: consolidate Intestines. Unstopping sweating: consolidate Skin/Hair. Unstopping bleeding: consolidate Ying/Wei. Leakage due to Cold: consolidate with Heat. Leakage due to Heat: consolidate with Cold. Upper/Exterior: consolidate Qi. Lower/Interior: consolidate Essence. Deficiency can be consolidated; Excess cannot. Chronic can be consolidated; Acute cannot. Failing to consolidate when needed drains the ocean; consolidating when inappropriate locks the thief inside.

Following Formulas are designed to follow indications. Similar diseases can be treated similarly. Abscess swelling: apply poultice. Snake/insect bite: resolve toxin. Scald/burn: dissipate Heat. Fracture/dislocation: reconnect bones. These are drug treatments based on symptoms. However, "following" has limits: same symptoms, different causes. Patients vary in Deficiency/Excess/Cold/Heat, Exterior/Interior/Yin/Yang; treatments must be classified. What suits one may not suit another. Similar exterior may differ in interior. Similar diseases do not mean all "Following Formulas" are applicable. "Following" can refer to following symptoms (biao) or root (ben). Do not misunderstand the term "Following Formula." (From *Jingyue Quanshu*)

Most beware of hearsay, "roadside talk." Treating floating Fire requires guiding Fire back to its source. Ba Wei Wan (Eight-Ingredient Pill) is for Kidney deficiency-cold where Fire cannot be anchored, not for Excess Fire or Fire in other organs. Di Huang Yin Zi (Rehmannia Decoction) for apoplexy-like stroke treats Shaoyin pure deficiency Fei syndrome, not Wind-Fire-Phlegm stroke. Da Shun San (Great Harmony Powder) in summer treats Cold from overcooling, not Summerheat proper. Lu Hui Wan (Aloe Pill) for constipation treats hard fecal impaction resistant to other drugs, not dryness of fluids. Moderns hear of these formulas, fail to examine causes, use blindly, and suffer severe consequences. (From *Lantai Guifan*)

Prescribing without distinguishing Sovereign, Minister, Assistant, Courier roles, resulting in chaos and arbitrary administration, where medicine does not match disease, is the doctor's fault. (From *Yimen Falü*)