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A question was asked: "What is the most difficult aspect in treating diseases?" I replied: "This cannot be fully explained in a short passage. I will briefly list a few examples, from which others can be inferred." For instance, cold above and heat below, or heat above and cold below; pathogenic factors affecting both the exterior and interior, with simultaneous disorders of Qi and Blood; latent pathogens (Fuxie) not yet cleared while Zhengqi (Upright Qi) is already deficient; furthermore, there are cases where disease in one Zang organ is treated by regulating another Zang organ. If pattern differentiation (Bianzheng) is slightly unclear, it is rare that such treatment does not lead to error.

What is meant by "cold above and heat below"? For example, aversion to wind with fever, accompanied by abdominal pain and bloody dysentery. One must first disperse the cold pathogen, and then use heat-clearing medicines.

What is meant by "heat above and cold below"? For example, coughing with hemoptysis, accompanied by loose watery stools and cold feet. Former sages used Bawei Tang (Eight-Ingredient Pill with Rehmannia, taken cold). The cold administration caters to the preference for coolness due to upper heat, while Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) eliminate lower cold.

What is meant by "pathogens affecting both exterior and interior, with Qi and Blood simultaneously diseased"? For example, alternating chills and fever, accompanied by bloody dysentery and abdominal pain. Both exterior and interior must be addressed simultaneously, using Chai Ping Tang (Bupleurum and Pinellia Decoction) added with Huanglian (Coptis Rhizome) and Zhari Rou (Hawthorn Flesh); or if there is unremitting high fever, headache, aversion to wind, abdominal fullness and distension with tenderness upon pressure, Da Chaihu Tang (Major Bupleurum Decoction) and similar formulas should be used.

When pathogens remain but Zhengqi is already deficient, one must distinguish the severity of the pathogen and the degree of deficiency. Tonification should be combined with draining, and draining with tonifying. It must be handled with the precision of balancing weights on a scale to achieve success. Regarding treating disease in one Zang organ by regulating another, this refers to the method of "skipping one or two organs," which essentially involves tonifying the Mother organ in deficiency patterns and purging the Child organ in excess patterns.

Acute diseases are also difficult to treat. If treated correctly, recovery occurs almost instantly; otherwise, even an hour is hard to endure. Take urinary retention as an example; the causes vary. In cases of strangury caused by Damp-Heat, opening the Taiyang meridian qi is obvious and needs no further explanation. Li Dongyuan once treated a patient with urinary retention, abdominal distension like drum-tightness, who could neither live nor die. After deep contemplation until midnight, he suddenly had an insight and cured the patient using Zishen Wan (Kidney-Nourishing Pill). Zhu Danxi treated another patient who pondered deeply until inspired by seeing water being poured, curing him using the emetic method. Both accounts are recorded in their respective books and need not be repeated here. These two were renowned physicians, yet they found treatment so difficult; how much more so for later generations!

Cold-natured medicines harm people subtly, often going unnoticed; hot-natured medicines harm people visibly, showing effects after just one dose. In the past, a patient with cough and hemoptysis was treated by a physician using blood-cooling herbs such as Shengdi Huang (Rehmanniae Radix) and Mudan Pi (Moutan Cortex). The patient was pleased that the bleeding stopped. With minor adjustments over dozens of doses, the cough did not subside, appetite gradually decreased, and the patient, unaware of the cause, eventually died from abdominal distension (Guzhang). Alas! This illustrates how cold-natured medicines harm people without their awareness. Another case involved a Mr. Li from Nancheng with unspecified symptoms, unresponsive to various physicians. Yu from Luxu was invited to treat him and cured him with two doses of Bawei Tang. The following year, the illness recurred with identical symptoms. Yu was consulted again and prescribed the same Bawei Tang, but the patient died after the first dose. This illustrates how hot-natured medicines harm people and the errors are easily seen. Ancients compared hot medicines to Junzi (gentlemen) and cold medicines to Xiaoren (petty men). A gentleman, if he errs, people will surely know. As a person, this is acceptable; but medicine concerns life and death. If used improperly, even a "gentlemanly" medicine has its drawbacks; how much worse, then, for a "petty man" medicine?