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It is well said; the method for treating excess patterns has been grasped. However, pain syndromes also have deficiency and excess distinctions, and treatment methods include tonification and purgation. The methods for differentiation must be examined in detail. Generally, pain accompanied by distension and obstruction indicates excess; pain without distension or obstruction indicates deficiency. Pain that refuses pressure indicates excess; pain that can be pressed indicates deficiency. Preference for cold indicates excess; preference for heat indicates deficiency. Aggravation after fullness indicates excess; aggravation on an empty stomach indicates deficiency. A surging pulse with coarse breathing indicates excess; a deficient pulse with weak breathing indicates deficiency. Recent onset in young adults indicates excess; worsening with aggressive treatment indicates deficiency. Pain in the meridians often presents with wiry and large pulses; pain in the zang-organs often presents with deep and faint pulses. One must observe both pulse and symptoms to clearly distinguish between deficiency and excess. Can excess conditions be treated with draining methods? Can deficiency conditions also be treated with draining methods? If draining is used when inappropriate, the harm will be profound. Therefore, for exterior deficiency causing pain, it is due to insufficient Yang Qi (Yang energy); warming the meridians is indispensable. For interior deficiency causing pain, it is due to insufficient Yin Blood (Yin fluid); nourishing the Ying (Nutritive) level is indispensable. For upper deficiency causing pain, it is injury to the Heart and Spleen; tonifying the Middle Jiao (Middle Burner) is indispensable. For lower deficiency causing pain, it is loss of Yin fluids through diarrhea or leakage; rapidly rescuing the Spleen and Stomach and warming the Mingmen (Gate of Life) is indispensable. Using warming and tonifying methods to treat pain was not uncommon among ancient physicians, but figures like Xue Lizhai and Wang Shishan in recent times particularly mastered this approach. Why did Zhu Danxi, who seemed enlightened, state that "all pains should not be treated with Qi-tonifying herbs"? This is merely adhering to personal opinion; is it truly a good method?

Kongtongzi stated: The Earth element of the Spleen corresponds to Heaven above and belongs to the transformation of Dampness. Thus, if the fluids from food and water fail to circulate, they stagnate and accumulate to form Phlegm-Fluids (Tan-Yin). Eight or nine out of ten patients suffer from Phlegm-Fire. Elderly people should not have their Fire rapidly reduced, and deficient individuals should not have their Phlegm completely eliminated. Over-aggressive attack will worsen the condition and lead to danger; one must take consolidating Yuan Qi (Original Energy) as the foundation. By applying this reasoning to diseases, one understands more than half. I (Yu Chang) note: Medicines are meant to overcome disease, but if they overwhelm the Spleen and Stomach's capacity to bear them, and this is not observed, once Yuan Qi is damaged, myriad complications arise. For example, if Spleen deficiency causes shortness of breath that cannot continue, transforming into apparent panting, yet one still uses Qi-descending and pantling-stopping herbs; if Spleen deficiency prevents Wei (Defensive) Qi from circulating, transforming into edema, yet one still uses Qi-consuming and diuretic herbs; if Spleen deficiency causes stagnation, transforming into alternating chills and fever, yet one assumes external invasion and uses dispersing herbs—this makes the deficient even more deficient, leading to exhaustion of Qi and death, with no remorse for the disaster. Applying such methods to others results in endless killing, which is unpardonable!

Guo Xiao proposed a method of differentiating deficiency and excess in treatment. He stated that diseases arise from external invasions and internal injuries, generating Fire and Dampness; Dampness and Heat generate Phlegm. These four factors suffice. For young, strong individuals with recent illness: if it is Dampness, dry it; if it is Fire, purge it. If Dampness generates Heat, dry Dampness and clear Heat simultaneously; if Fire generates Phlegm, purge Fire and resolve Phlegm simultaneously, leaving nothing unaddressed. For elderly individuals with chronic illness, one must combine attacking and tonifying. For instance, if Qi deficiency exists alongside Damp-Heat, Phlegm, and Fire, use Si Jun Zi Tang (Four Gentlemen Decoction) to tonify Qi, while simultaneously drying Dampness, clearing Heat, resolving Phlegm, and purging Fire. If Blood deficiency exists alongside Phlegm-Fire, Damp-Heat, use Si Wu Tang (Four Substances Decoction) to tonify Blood, while simultaneously purging Fire, resolving Phlegm, clearing Heat, and drying Dampness. In this way, attacking and tonifying are appropriate. Thus, it is said: for young, strong individuals with recent illness, attacking pathogens can be assessed carefully; for the elderly and those with chronic illness, tonification comes first. Regarding Yin deficiency with Fire hyperactivity and Spleen-Stomach weakness: True Yin is Water, and Spleen-Stomach is Earth. Although Earth prefers dryness, excessive dryness causes vegetation to wither; although Water prefers moisture, excessive moisture causes vegetation to rot. Therefore, formulas for tonifying Spleen and nourishing Kidney must ensure proper balance of dryness and moisture, adjusted according to symptoms.

Guo Xiao also proposed a method of differentiating Fire and Dampness. He stated that obese individuals have Qi deficiency generating Cold, Cold generating Dampness, and Dampness generating Phlegm. Emaciated individuals have Blood deficiency generating Heat, Heat generating Fire, and Fire generating Dryness. Thus, obese people mostly suffer from Cold-Dampness, while emaciated people mostly suffer from Heat-Dryness.

Treating disease involves three stages: Initial, Middle, and Terminal. The Initial stage requires fierce and drastic methods because the disease is new and sudden; one must urgently remove pathogens with rapid, potent medicines to prevent them from lingering and harming the body. The Middle stage requires a balance of leniency and severity. Since the disease is neither new nor long-standing, one must act with moderate speed, nurturing righteousness (Zheng Qi) while removing pathogens, combining both approaches. The Terminal stage requires lenient and slow methods; one should widely administer mild, safe, non-toxic medicines to stabilize the Middle Jiao and nourish Qi and Blood, allowing pathogens to depart naturally.

There are five methods for treating disease: Harmonizing (He), Taking/Attacking (Qu), Following (Cong), Breaking/Restraining (Zhe), and Seeking the Root/Category (Shu).
1. Harmonizing: For mild heat, use cool medicines to harmonize.
2. Taking: For slightly intense heat, use cold medicines to attack/purge.
3. Following: For severe heat, use warm medicines to follow/comply, or administer cold medicine hot, or cold medicine warm, or induce sweating.
4. Breaking: For extreme heat, use counteracting methods, such as purgation.
5. Seeking the Root: When heat sinks deeply into the marrow and cannot be expelled by needles or medicines, seek its root category to diminish it.
I (Yu Chang) note: The method of "seeking the root" is explicitly stated in the *Neijing* (Inner Canon): "For those who become hotter despite cold treatment, treat the Yin; for those who become colder despite heat treatment, treat the Yang." This is seeking the root. It also states: "If great cold persists and heating fails to warm, there is no Fire; assist the Heart." "If great heat persists and cooling fails to cool, there is no Water; assist the Kidney." Furthermore, "Assisting the Heart does not require uniform heat; assisting the Kidney does not require uniform cold." Simply benefiting Heart Yang allows cold to circulate; strengthening Kidney Yin allows heat to dissipate. The meaning is subtle and precise. The text inserts nonsensical phrases about Fire declining at Xu hour and Metal declining at Chen hour, blinding future generations; I correct this here.

There are eight essentials in treating disease. If these eight are not examined, the disease cannot be removed—not because the disease won't go, but because the physician lacks the means. One must discern these eight essentials to avoid error.
1. Deficiency: The Five Deficiencies—fine pulse, cold skin, shortness of breath, diarrhea/incontinence, inability to eat.
2. Excess: The Five Excesses—surging pulse, hot skin, abdominal distension, blockage of bowels/bladder, oppression/dizziness.
3. Cold: Accumulated cold in Zang-Fu organs.
4. Heat: Accumulated heat in Zang-Fu organs.
5. Pathogen: Disease not originating from Zang-Fu organs themselves.
6. Righteousness (Zheng): Not invaded by external pathogens.
7. Interior: Disease not located externally.
8. Exterior: Disease not located internally. Examining these eight essentials, combined with pulse diagnosis and pathogenesis analysis, prevents error.

Scholar Shang Lu said: Medicine relies on intuition, like a general facing an enemy or a boatman navigating waters. It values adapting to circumstances. Formulas are hard to apply exhaustively, but without them, the wisdom of ancients is lost, leaving one茫然 like gazing at the ocean or catching wind, inevitably leading to arbitrary errors. Can formulas be unused? Although formulas are good, one must master the *Suwen* (Basic Questions) to find the root; master Materia Medica to understand usage; master diagnosis to observe symptoms; master treatment to understand variations. Starting with using formulas and ending with needing no formulas—that is the completion of medical Dao. This discussion on learning and using formulas is most precise.

The *Bai Zhai San Shu* states: Each medicine has its specific function. The primary agent is the Sovereign (Jun) herb; assistants are Ministers (Chen) herbs; those contrary to the Sovereign but aiding it are Assistant (Zuo) herbs; those guiding other herbs to the lesion are Envoy (Shi) herbs. For example, treating Cold with Hot herbs makes the Hot herb the Sovereign; all warming herbs serve as Ministers. However, if Hot herbs are too strong and harmful, a small amount of Cold/Cool herbs is added to control them, preventing harm—this is the Assistant role. For each Zang-Fu organ and lesion site, guiding herbs are needed to bring the medicine to the disease—this is the Envoy role. Other diseases follow this logic. Bai Zhai's theory on medication weighting is precise. The old rule of "One Sovereign, Two Ministers, Three Assistants, Four Envoys" should not be rigidly applied. The *Materia Medica Theory* claims the herb with the strongest flavor is Sovereign, followed by Minister/Assistant, and toxic herbs are Envoys; this is absurd. If breaking hardness and eliminating accumulations, how could Da Huang (Rhubarb) or Ba Dou (Croton Seed) not be Sovereign?

A Jin dynasty scholar wished to correct the *I Ching* and various medical formulas, discussing this with Zu Ne. Zu Ne said: Correcting classics, even with differences, does not harm moral teachings. But slight errors in decoctions determine life and death, causing much harm to later generations; one should not lightly judge them. Zu Ne's words were benevolent. Today, talented scholars aspiring to medicine should delve into deep principles, yet they imitate Qi people knowing only Guan Zhong and Yan Ying, inserting *Tao Shi Liu Shu* into Zhang Zhongjing's established methods, causing even greater harm to later generations.

A physician must be entrusted only to those with Ren (Benevolence); appointed only to those intelligent and logical; trusted only to those honest and pure. Ancient selection of physicians required virtue of benevolence and broad love, intelligence for clear understanding, knowledge of heaven and earth, understanding of life/death and fortune/misfortune, distinguishing deficiency/excess, determining favorable/unfavorable trends, assessing disease severity, and dosing accurately. Only such profound insight qualifies as a good physician. How can superficial scholarship achieve this? (*Chuxue Ji*)

Medicine aims to save lives, closely aligning with Confucian Dao. Since the *Book of Tang* listed it as a skill, Confucians disdained it. Practitioners today merely recite one school's theories, stick to fixed formulas, hoping for accidental success, without exploring deeper to understand the integration of Yin-Yang and creation, nor reading broadly to adapt treatments. Worse, they abandon ancient formulas, attach to subjective views, confusing each other, causing much harm. Is this the sincere intent of sages to benefit people? I (Yu Chang) note: During the Spring and Autumn period, Zuo Qiuming discussed medical principles thoroughly; Han Confucians neglected medicine; Sima Qian's biography of Cang Gong rarely elaborated; what of others? Later, biographies like Hua Tuo's became mythical. The break in medical lineage was actually initiated by Confucians. Thus, listing medicine as a technical skill in Tang is not surprising. The *Jiu Lingshan Fang Wenji* argues physicians must read broadly, seek sage wisdom, and understand creation's integration—isn't this expectation grand? (Dai Shuming)

The Dao of medicine requires precision to understand principles and breadth to reach simplicity. Hence, predecessors insisted students first read Confucian classics, mastering *Yi Li*, *Suwen*, *Nanjing*, *Bencao*, and *Maichuang*. Why? Without the Four Books, one cannot grasp subtle principles; without *I Ching*, one cannot know Yin-Yang waxing/waning; without *Suwen*, one cannot recognize disease; without *Bencao*, one cannot recognize herbs; without *Maichuang*, one cannot diagnose cold/heat/deficiency/excess. Sages briefly outlined the beginning. Students must synthesize strengths of many books, combine insights, and treat accordingly. (*Yixue Jicheng*)

To tune pentatonic notes, one must follow Shi Kuang's pitch pipes. To make squares/circles, one must follow Gongshu Ban's compass/square. Musical and geometric skills are minor arts, yet experts are sought; how much more so for medicine, which holds life and death? Imprecision kills. Patients today do not understand this, entrusting fate to contemporary doctors, equivalent to self-abandonment. Thus, six failures in illness: failure to examine carefully, failure to believe, delay, failure to choose doctor wisely, ignorance of disease, ignorance of medicine. Also, *Shiji* lists six untreatable cases: arrogant/illogical, valuing wealth over health, improper clothing/diet, chaotic Yin-Yang/Zang-Qi, emaciation unable to take medicine, believing in witchcraft over medicine. These are common faults of modern patients. (From this collection)

Many relatives/friends ask about illnesses, having no experience or reading formulas, pretending to be knowledgeable, spreading heretical theories. Some say deficiency, some excess; some wind, some Qi; conflicting false statements confuse patients, delaying treatment until disaster strikes. This situation is especially prevalent today. (Sun Simiao)