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[Scriptural Principles]

In ancient times, treating diseases only required shifting the patient's spirit and altering their Qi flow, which could be cured through Zhuyou (a therapeutic method involving chanting the cause of illness). Nowadays, people treat diseases internally with medicinal herbs and externally with needles and stones; some recover, while others do not. Why is this? In ancient times, people lived among beasts, moving to avoid cold and dwelling in shaded areas to avoid heat. Internally, they had no burdens of longing or attachment; externally, they had no forms of labor for official duties. This was an era of tranquility and emptiness, where pathogenic factors could not penetrate deeply. Therefore, toxic medicines could not treat internally, and needles/stones could not treat externally, so merely shifting the spirit and using Zhuyou therapy was sufficient. In middle antiquity, when treating diseases, if pathogens had just arrived, decoctions were used, which could eliminate diseases like Eight Winds and Five Bi syndromes within ten days; if not cured after ten days, branches of grass roots (Caosu, Caogai) were boiled for administration. In later ages, treatment was different: one did not base it on the four seasons, did not understand the laws of sun and moon, did not examine reversals and compliance, and waited until the disease form was already established before attempting to treat externally with fine needles and internally with decoctions. Incompetent physicians acted frantically, believing attack was possible, resulting in old diseases persisting and new diseases arising. ○ Treating disease must seek its root. If illness precedes Qi/Blood rebellion, treat the root; if Qi/Blood rebellion precedes illness, treat the root. If cold sensation precedes illness, treat the root; if illness precedes cold sensation, treat the root. If fever precedes illness, treat the root; if illness precedes fever, treat the root. If illness precedes diarrhea, treat the root; if diarrhea precedes other illnesses, treat the root. If illness precedes abdominal fullness, treat the branch; if abdominal fullness precedes mental restlessness, treat the root. For obstruction of urination and defecation, treat the branch; for free passage of urination and defecation, treat the root. If obstruction of urination/defecation precedes illness, treat the root. If the condition contradicts the root, branch diseases appear; if treatment contradicts the root, branch-targeted prescriptions are used. Discussing branch and root, the principle is simple but should not be neglected. Examining root and branch allows Qi to be regulated. ○ If pathology moves from interior to exterior, regulate the interior; if from exterior to interior, treat the exterior; if from interior to exterior and severe externally, first regulate interior then treat exterior; if from exterior to interior and severe internally, first treat exterior then regulate interior; if interior and exterior pathologies are unrelated, treat the primary disease. ○ Investigate those with excess, investigate those without; hold accountable for those with abundance, hold accountable for those with deficiency; use heat for cold, cold for heat; reverse-treat mild cases, follow-treat severe cases; reduce hardness, remove exogenous pathogens, warm asthenia, dissipate knots, attack stagnation, moisten dryness, relieve spasm, astringe dispersion, tonify loss, promote逸 (inactivity), calm fright, descend upper, raise lower, massage, bathe, force,劫 (coerce), open, develop—adapt to the situation as the goal. Reverse-treatment is Zhengzhi (Orthodox Treatment); following-treatment is Fanzhi (Reverse Treatment). Use heat due to cold, cold due to heat. Use obstruction for obstruction, patency for patency. Must subdue the master pathogen and address the cause first; initially similar, finally different. ○ At the onset of disease, acupuncture may suffice; if excessive, wait for decline. Due to lightness, disperse; due to heaviness, reduce; due to weakness, manifest/support. For insufficiency of form, warm with Qi; for insufficiency of essence, tonify with flavor. For high locations, induce vomiting; for low locations, drain via bowels/bladder; for middle fullness, purge internally. For those with pathogens, soak the body to induce sweat. For those in the skin, release via sweating. For those who are swift and fierce, press and gather. For excess, scatter and purge. For blood excess, puncture/drain; for Qi deficiency, guide and pull. ○ Open the ghost gate (sweat pores), cleanse the clean府 (bladder), remove stale accumulation, invert the granary (digestive tract). ○ For Wind invading internally, treat with acrid-cool, assist with bitter-sweet, soothe with sweet, disperse with acrid. For Heat invading internally, treat with salty-cold, assist with bitter-sweet, astringe with sour, vent with bitter. For Dampness invading internally, treat with bitter-hot, assist with sour-bland, dry with bitter, seep with bland. For Fire invading internally, treat with salty-cold, assist with bitter-acrid, astringe with sour, vent with bitter. For Dryness invading internally, treat with bitter-warm, assist with sweet-acrid, purge with bitter. For Cold invading internally, treat with sweet-hot, assist with bitter-acrid, purge with salty, moisten with acrid, firm with bitter. (*Suwen*)

If physical constitution and Qi are deficient but pathological Qi is abundant, this is pathogen excess; urgently purge it. If physical constitution and Qi are abundant but pathological Qi is deficient, urgently tonify it. If both physical constitution/Qi and pathological Qi are deficient, this is Yin-Yang deficiency; do not needle, as needling causes double deficiency, leading to exhaustion of Yin-Yang, depletion of Blood/Qi, emptiness of Zang-Fu, death for the elderly, and non-recovery for the strong. If both physical constitution/Qi and pathological Qi are abundant, this is Yin-Yang excess; urgently purge pathogens, regulate excess/deficiency. Thus: Excess requires purging; deficiency requires tonifying. (*Lingshu*)

For inexplicable diseases, abstaining from medicine brings joy/recovery. (*I Ching*)

Surgeons manage preparations for applying medicine, scraping, and killing agents for swelling ulcers, open ulcers, metal wounds, and fracture wounds. (*Rites of Zhou*)

Removing disease must be thorough. (*Zuo Zhuan*)

If Yang Qi is deficient and Yin Qi is abundant, first tonify Yang, then purge Yin. If Yin Qi is deficient and Yang Qi is abundant, first tonify Yin, then purge Yang. The smooth circulation of Ying and Wei is key. (*Nanjing*)

[Philosophical Sayings]

A medical king can cure all diseases but cannot cure someone whose life span has ended. (*Shurangama Sutra*)

Bian Que cannot make the dead live or the living die; he merely awakens those who were destined to survive. (*Records of the Grand Historian*)

Superior doctors treat disease before it arises. Why? Treating before arising means seeing Liver disease, knowing Liver transmits to Spleen, and thus first strengthening the Spleen; average doctors do not understand transmission, see Liver disease, fail to strengthen the Spleen, and only treat the Liver. (*Jingui Yaolue*)

The human body is like a state. Chest and abdomen are like palaces; limbs are like borders; joints are like officials; Spirit is like the ruler; Blood is like ministers; Qi is like the people. Knowing how to govern the body enables governing the state. Loving the people stabilizes the state; cherishing Qi preserves the body. Thus sages prevent unarisen disasters, treat unarisen diseases, heal before events occur, and do not pursue after they pass. Then True One remains, Three Ones are guarded, hundred diseases recede, and lifespan extends. (*Baopuzi*)

Ancient divine physicians could heal the human mind, preventing illness beforehand. Modern physicians only know how to heal the body's disease but not the mind; this is abandoning root for branch, failing to clear the source while blocking the flow, yet seeking recovery—is this not foolish? (Sun Simiao)

Good physicians must first seek the cause of disease. For Deficient Pathogens, treat the Mother organ; for Excess Pathogens, treat the Child organ; for Minor Pathogens, treat the organ they overcome; for Hostile Pathogens, treat the organ that overcomes them; for Direct Pathogens, treat the primary meridian. For mixed pathogen invasion, observe the severity of mixing and the urgency of root/branch to determine treatment sequence. (*Ju Fang Fa Hui*)

Eight essentials of treatment: 1. Deficiency (Five Deficiencies); 2. Excess (Five Excesses); 3. Cold Zang-Fu (chronic cold accumulation); 4. Hot Zang-Fu (chronic heat accumulation); 5. Pathogen (not Zang-Fu proper disease); 6. Proper Qi (not external pathogen invasion); 7. Interior (disease not external); 8. Exterior (disease not internal). Examining these eight essentials, combined with pulse and pathogenesis, ensures few errors. (Shang Lu)

Treatment divided into Early, Middle, Late stages. Early stage: method should be fierce/strong because disease is new/sudden; use fierce drugs to drive out pathogens quickly. Middle stage: method should balance leniency and severity; disease is neither new nor long-standing; use moderate speed, nourish proper Qi, remove pathogens, combining both. Late stage: method should be lenient, frequent administration, mild/non-toxic, nourish Blood/Qi, allowing pathogens to leave naturally. ○ Five treatment methods: 1. Harmonize (He): e.g., slight heat treated with cool herbs; if ineffective, proceed to 2. Purge (Qu): heat slightly larger, use cold herbs to purge; if ineffective, proceed to 3. Follow (Cong): heat very severe, use warm herbs to follow, or hot-for-cold usage; if ineffective, proceed to 4. Subdue (Zhe): disease extremely severe, use reverse control; if ineffective, proceed to 5. Drain/Lower (Xia Duo); if ineffective, proceed to 6. Belong/Seek Category (Shu): seek belonging to weaken, as heat deep in marrow is inaccessible to needles/drugs. Seeking belonging follows "same sound responds, same Qi seeks." ○ High positions suppress them (not because high must be suppressed, but because originally low and lost too high, so suppress to lower); Low positions lift them (not because low must be lifted, but because originally high and lost too low, so lift to raise). (*Ci Shi Nan Zhi*)

*Classic* says: Treat disease by seeking the root. Briefly: Death uses Life as root; to save death, do not harm life; Righteousness uses Pathogen as root; to attack pathogen, protect righteousness; Yin uses Yang as root; Yang exists = life, Yang exhausted = death; Stillness uses Movement as root; Movement = life, No movement = stop; Blood uses Qi as root; Qi comes = flow, Qi goes = coagulation; Syndrome uses Pulse as root; Auspicious pulse = auspicious outcome, Inauspicious pulse = inauspicious outcome; Earlier uses Later as root; From here comes, must go from here; Urgent uses Slow as root; Who is urgent/worrying, who is slow/carefree? Interior uses Exterior as root; Exterior excess harms nothing? Interior collapse is feared; Lower uses Upper as root; Nourish shoots by rooting; Cut lower, upper withers; Deficiency uses Fullness as root; Removing excess is easy; attacking deficiency is cruel? Truth uses Falsehood as root; Shallow knows only present; Profound sees clearly in ambiguity. Ultimately, seeking root means nothing else but not harming life. ○ "Pathogen excess is Excess, Essence loss is Deficiency" is the general outline of treatment. Words seem obvious, meaning subtle. Hardest to distinguish: "Excess" means pathogen excess, suitable for purging; "Deficiency" means proper Qi deficiency, suitable for tonifying. When pathogen and proper Qi struggle, both can be described as excess/deficiency. Pro-purging say: Pathogen excess = Excess, Excess needs purging. Pro-tonifying say: Essence loss = Deficiency, Deficiency needs tonifying. Each holds one sentence, confused, using text to justify, who is right/wrong? Thus, profound teaching酿 (brews) great harm. Not knowing the immutable reason, I analyze this into four: Which slow, which urgent, Which has, Which lacks. Slow/Urgent refers to observing deficiency/excess urgency. No deficiency: urgency lies in pathogen; slow removal leads to changes. Much deficiency: urgency lies in proper Qi; late tonification fails at critical moment. Slight excess/deficiency: treat excess only, sweep away. Severe excess/deficiency: fear deficiency; solidify root, pathogens retreat. Two deficiency/one excess: treat excess concurrently, open one side. Two excess/one deficiency: treat deficiency concurrently, prevent unpredictability. Overall: Excess mistook for tonification increases pathogen, still salvageable, small disaster; Deficiency mistook for purging loses True Qi suddenly, irrecoverable, large disaster. Observe deficiency/excess urgency. Has/Lacks refers to observing pathogen presence. Wind/Cold/Summer-heat/Dampness/Dryness/Fire become pathogens; residing in exterior/interior/fu/zang, find root, attack directly. This is "Has," meaning pathogen excess. If no Six Qi pathogens, but disease from Three Yin, caused by desires injuring interior, fatigue injuring exterior, non-pathogen-like-pathogen, non-excess-like-excess. This is "Lacks," meaning disease in Yuan Qi. Ignoring deficiency/excess/has/lacks leads to mistaking reverse for following, branch for root, cutting off long life. Be cautious! (*Leijing*)

Treatment principles: Know pathogen/proper, weigh heavy/light. Treating excess is like weeding rice. Barnyard grass is rice thief; remove one grass, remove one; remove two grass, remove two. Good weeding. Remove one grass but kill two rice plants? Remove two grass but kill four rice plants? If misidentifying rice as grass, trying to remove all, no rice left. Using attack methods requires true observation, not excess. Treating deficiency is like supplying rations. One person one sheng, ten people one dou, daily ration sufficient. Hundred people one dou? Thousand people one hu? Can stone-carried grain feed three armies? If one ration fails, previous rations abandoned, let alone deductions. Using tonification requires appropriate weight. ○ Clinically, whether deficiency syndrome exists or not, if no excess evidence, combine tonification to regulate Ying/Wei/Blood/Essence Qi. Whether fire syndrome exists or not, if no heat evidence, combine warming to cultivate Mingmen/Spleen/Stomach Qi. ○ Tonification: light first, heavy later, ensure success. Attack: slow first, fast later, reach disease then stop. ○ Contemporary physicians only observe branch, not root. Only see urgency in disease, not in life. Which is slow? Which is urgent? Today urgent? Tomorrow more urgent? ○ Warming middle disperses pathogen; strengthening master expels bandit. ○ To release exterior, avoid sour/cold; to descend, avoid ascending/dispersing. Yang excess avoid warm; Yang deficiency avoid deep cold. Upper excess avoid ascending; Lower excess avoid constipation. Upper deficiency avoid descending; Lower deficiency avoid purging. Moving again scatters; Still again extinguishes. Sweet avoid middle fullness; Bitter avoid false heat; Acrid avoid heat/restlessness; Salty avoid blood injury; Sour/Wood overcomes Earth, Spleen deficiency use sparingly. ○ Prescription with counter-assistance (Fan Zuo) is Xuqi's principle, subtle weight of treatment. Later physicians misuse it, confusing norms, violating logic, harming future. *Neijing* says: Odd formula fails, use Even; Even fails, use counter-assistance. Cold/Hot/Warm/Cool follow disease. Meaning: Disease has slight/severe, true/false. First orthodox treatment; if fails, then counter-assistance. Necessary. Also: Mild reverse, severe follow. Reverse = Orthodox; Follow = Reverse. Cold treats Heat, Heat treats Cold = Reverse (Orthodox). Cold treats Cold, Heat treats Heat = Follow (Reverse). E.g., Heat treats Cold but Cold rejects Heat, counter-assist with Cold to enter; Cold treats Heat but Heat rejects Cold, counter-assist with Heat to enter. This is counter-assistance. Also: Hot for Cold use: Great cold internal knot, treat with Hot, but Cold rejects Hot, take Hot medicine cold; after swallowing, cold nature fades, hot nature acts, compliant, great benefit. Cold for Hot use: Great heat inside, Cold attack enters not, Hot attack increases disease, take Cold medicine hot; after entering stomach, hot nature fades, cold nature acts, harmonious, disease灭 (extinguished). These are counter-assistance. E.g., Zhang Zhongjing treating Shaoyin diarrhea: Bai Tong Tang (Orthodox); later irritability, add Pig Gallbladder Bile (Counter-assistance). Treating Huoluan vomiting/diarrhea faint pulse: Si Ni Tang (Orthodox); later sweating/minor irritability, Tong Mai Si Ni Tang + Pig Gallbladder Bile (Counter-assistance). Modern counter-assistance is different. Zhu Danxi: Acid regurgitation, Huang Lian (Monarch), Wu Zhu Yu (Assistant); Heart/Abdominal pain, Shan Zhi doubled, Gan Jiang (Assistant). If Heat, Cold suffices, why Gan Jiang/Wu Zhu Yu? If Cold, Heat suffices, why Huang Lian/Shan Zhi? Contradictory, errors inevitable? Counter-assistance is treatment flexibility. Classic is routine; Weight (Quan) is adaptation. Use weight outside classic rules, not随意 (casually) per case. What suits counter-assistance? Orthodox failure suits counter-assistance; Disease rejecting medicine suits counter-assistance; Extreme Fire resembling Water suits counter-assistance; Extreme Cold resembling Heat suits counter-assistance. True answers True, False answers False. If no rejection/false syndrome, naturally Orthodox, why counter? Inappropriate weight violates logic; inappropriate counter-assistance loses righteousness in attacking pathogen. How to confuse? (Zhang Jingyue)

Diseases suit Decoctions, Pills, Powders, Purging, Vomiting, Sweating, Moxibustion, Acupuncture, Tonification, Massage, Qigong, Steaming/Warming, Warm Washing, Joyful Regulation, Gentle Regulation, Water Therapy, Fire Therapy. Various methods; without excellent/broad knowledge, hard to cure. Mediocre/shallow doctors乱 (confuse) treatments, mix Decoction/Pill/Sweat/Purge/Tonify/Vomit, causing light to become heavy, heavy to die. Decoction cleanses Zang-Fu, opens meridians, regulates Yin-Yang, removes evil, moistens decay, nourishes skin, boosts strength. Pill drives wind/cold, breaks hardness, eliminates accumulation, promotes appetite, soothes Ying/Wei, opens orifices. Powder dispels Wind/Summer-heat/Dampness, captures Cold/Damp turbid toxins, disperses limb stagnation, cuts five Zang knots, opens Yang/harmonizes Stomach, moves pulses/meridians. Purging opens blockage. Tonifying aids deficiency. Moxibustion raises Yin/unblocks Yang. Acupuncture moves Ying/guides Wei. Qigong drives guest pathogens from joints. Massage drives floating pathogens from muscles. Steaming/Warming dispels cold; Warm washing generates Yang; Joy refreshes spirit; Gentle calms Qi. If Excess not purged: abdominal fullness,烦躁 (restlessness), edema. If Deficiency not tonified: Blood/Qi dissipate, muscle waste, spirit loss, coma. Sweatable but not sweated: pores closed, suffocation death. Should vomit but not: chest binding, panting, inability to eat/drink. Should moxa but not: cold coagulation, Yin toxin gathering, rebellious Qi rising, collaterals blocked. Should needle but not: Ying/Wei stagnation, meridian obstruction. Should Qigong but not: pathogens invade joints, hard to unblock. Should massage but not: pathogens linger in muscles. Should steam/warm but not: cold latent, Bi/Jue develops. Should warm wash but not: Yang not moving, Yin evil harming. Should purge but not: Yang opens/Stomach荡 (agitates), uncontrollable diarrhea. Should not sweat but sweated: muscle waste, fluid exhaustion. Should not vomit but vomited: heart/mind chaotic, Zang-Fu rushing. Should not moxa but moxed: severe meridian injury, internal accumulation...