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This further illustrates that the application of prescriptions cannot be rigidly adhered to. Therefore, in all methods of tonifying deficiency, one must clearly understand the properties of Yin and Yang, ascending and descending, cold and heat, warm and cool, as well as the interdependence of essence containing Qi and Qi containing essence.

Furthermore, whenever there is a deficiency of Yang Qi in the Upper Jiao (Upper Burner), it inevitably sinks into the Kidney; thus, one should select herbs from the lowest Yin level. Conversely, when there is a deficiency of True Yin in the Lower Jiao, it often floats upward; therefore, is it not necessary to guide it back to its origin? Hence, treatment must seek the root cause to be perfect.

Once deficiency damage is established, without tonification, how can recovery be expected? However, for those who cannot tolerate herbs such as Renshen (Ginseng Radix) or Shudihuang (Rehmanniae Radix Praeparata), this is termed "deficiency unable to accept tonification" (Xu Bu Shou Bu). In such cases, how can survival be hoped for? If after blood loss, coughing persists without cessation and phlegm is excessive, this indicates extreme deficiency of the Spleen and Lung. Dietary intake fails to transform into blood and instead turns into phlegm with food consumption. Although this is not blood, it is essentially of the same category as blood. The Classics state: "If white blood is expelled, death ensues."

Some patients cannot lie on either side, finding it difficult to turn over in one direction; this results from an imbalance and exhaustion of Yin and Yang Qi, and is mostly incurable. If a deficiency syndrome presents with delirium and loss of reason, yet lacks other pathogenic heat, this signifies the failure of the Heart and the departure of Shen (Spirit); death is inevitable. In cases of consumptive cough leading to aphonia where voice cannot be produced, this indicates the failure of the Lung; death is inevitable. When consumptive disease leads to the complete wasting away of muscles, this indicates the failure of the Spleen; death is inevitable. Tendons are the root of fatigue (Ba Ji); if deficiency damage causes pain in tendons and bones, and the pain reaches an unbearable intensity, this is due to blood exhaustion failing to nourish the tendons, indicating the failure of the Liver; death is inevitable. After prolonged consumptive disease, if diarrhea becomes uncontrollable, this indicates the failure of the Kidney; death is inevitable.

*Zhi Fa Gang* states: Internal injury fever manifests with spontaneous sweating from within, weak pulses in all six positions, or the Qi Kou pulse on the right hand being three times larger than the Ying Keng pulse, feeling powerless upon pressure. The body feels sore or painful, there is fatigue in speech, and lethargy in movement. This belongs to internal injury of Yuan Qi (Original Qi) deficiency, and *Buzhong Yiqi Tang* (Spleen-Boosting Qi-Rescuing Decoction) with modifications is appropriate. Fever worsening in the afternoon, accompanied by seminal emission or slippery discharge, or coughing up blood, with dry and brittle skin and hair, belongs to Yin deficiency. Prolonged heat transforms into bone-steaming consumptive disease; the treatment method follows the section on Lao Zhai (Consumptive Disease). There is also fever caused by food stagnation, characterized by aversion to cold, headache, vomiting, nausea, chest fullness, distension, and pain. The Right Cun and Guan pulses are both tight and slippery, while the Left pulse is wiry and rapid. This belongs to internal injury from diet combined with external contraction of Wind-Cold heat. Initially, release the exterior; subsequently, resolve stagnation and harmonize the Middle Jiao. There is also fever that is severe during the day and light at night, with a tasteless mouth, belonging to Yang deficiency; fever in the afternoon ceasing at midnight belongs to Yin deficiency. Yang deficiency is attributed to the Stomach, while Yin deficiency is attributed to the Kidney. Generally, irregular eating harms the Stomach, and sexual excess harms the Kidney. Regarding medicinal theory: Sweet-Warm tonifies Qi, Sweet-Cool nourishes Yin. If both Qi and Blood are deficient, tonifying Qi alone allows abundant Yang to generate Yin.

Li Dongyuan stated: Fever during the day and quietness at night indicates Yang Qi flourishing in the Yang divisions. Fever at night and quietness during the day indicates Yang Qi sinking into the Yin, named "Heat entering the Blood Chamber". Fever and irritability both day and night indicate Extreme Yang without Yin; one must urgently drain the Yang and vigorously tonify the Yin.

Wang Bing stated: When a patient has fever but the pulse appears normal, and pressing reveals no pulsation, this is caused by Cold excess repelling Yang, not true Heat. When symptoms and signs indicate Cold, but pressing reveals a pulsating pulse under the fingers, this is Heat excess repelling Yin, not true Cold.

Zhao Yangkui stated: Fever with thirst, desire for cold drinks, and constipation belongs to Excess Heat, which everyone knows. Aversion to cold, fever, curling up holding clothes, cold limbs, and loose stools belong to True Cold, which is also easily known. However, restlessness, mania, dislike of clothing, and desire to sit in mud or water belong to False Heat syndromes. Severe cases involve extreme restlessness, incessant thirst, tongue like thorns, cracked lips, face painted red, body feeling like burning, soles of feet like iron branding, profuse expectoration,急促 breathing, constipation, and scanty urination. The three positions of the pulse are flooding and boundless. At this time, it resembles a Chengqi Syndrome, but if Chengqi Tang enters the mouth, death follows immediately; it resembles a Baihu Syndrome, but if Baihu Tang is swallowed, death follows. Erwan pills are too slow. Urgently use Jiajian Bawei Wan formula (Modified Eight-Ingredient Pill) in large quantities, adding Rougui (Cinnamon Bark), decocted in water to yield several bowls, served cold. Symptoms will recede. The next day, there will likely be aversion to cold and deep pulse, indicating absence of Fire; one must tonify Yang, urgently using Fuzi Bawei Wan (Aconite Eight-Ingredient Pill) decoction to heal. This syndrome and pulse deviate from norms and require non-standard treatment. In cases of postpartum or massive blood loss, sudden injury to Yin Blood causes high fever, also called Yin Deficiency Fever. Using cooling medicines for direct treatment leads to immediate death. As the saying goes, resembling Baihu Syndrome, taking Baihu Tang causes death. One must use Dushen Tang (Single Ginseng Decoction) or Danggui Buxue Tang (Angelica Tonifying Blood Decoction) to generate the formless (Qi), illustrating the wonder of "Yang generating Yin". Someone asked: Qi deficiency and Blood deficiency are both internal injuries; how to distinguish them? Answer: In Yin deficiency, the face must be red, with rootless Fire floating upwards. In Yang syndromes, Fire enters inward, and the face is not red. Those with thirst have dried-up Kidney Water, drawing water to save themselves. Although the mouth is thirsty, the tongue must be slippery; although the pulse is rapid, the Chi position must be powerless. Even if the Chi position is flooding and rapid, pressing reveals no pulsation; this is the key to differentiation. Dai Fu'an said: If the pulse remains rapid after taking cooling medicines, it is Fire Depression, suitable for lifting and tonifying.

Wang Jiezhai stated: Among fevers in the world, several resemble Taiyang disease (Shanghan), but treatments differ greatly. External contraction and internal injury are the major keys. Zhang Zhongjing's discussion on Shanghan and Shangfeng refers to external contraction. Wind-Cold enters from the exterior to the interior, so releasing the exterior to dissipate is indicated; this is the principle of Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction). Because contraction occurs in the cold seasons of Winter and Spring, pungent-hot herbs are used to overcome cold. If the season is not cold, the herbs must change. In warm Spring months, pungent-cool herbs are used; in hot Summer months, sweet-bitter-cold herbs are used. Thus it is said: Shanghan that does not manifest immediately may transform into Wenbing (Warm Disease) in Spring and Rebing (Heat Disease) in Summer. Treatment methods must vary according to the season. There is also a winter-warm disease, called having the qi of another season; though it is winter cold, one contracts warmth. This is improper seasonal qi, with Yang leaking; warming herbs are contraindicated. There is also a seasonal cold epidemic occurring in warm times, where cold becomes the disease. This is also improper seasonal qi, with Yin reversing; cooling herbs are contraindicated. There is also a pandemic warm-febrile disease, occurring mostly in early Spring and Summer, affecting entire households similarly. This is a pestilential qi of Heaven and Earth; treatment should follow the season and consult the Six Qi transformations, using Liu Hejian's pungent-cool, sweet-bitter-cold herbs to clear heat and detoxify. All above syndromes are external contractions of Heaven and Earth's pathogenic qi.

However, dietary irregularity and fatigue injure Yuan Qi internally, causing True Yang to sink and generating internal deficiency heat. Thus Li Dongyuan proposed the theory of Buzhong Yiqi, using Renshen and Huangqi (Astragali Radix) and other sweet-warm herbs to tonify Qi and lift the sunken Qi. This uses Qi-tonifying herbs to supplement insufficient Qi.

Furthermore, mental overwork and sexual indulgence injure True Yin internally. Once Yin Blood is injured, Yang Qi becomes relatively excessive and transforms into Fire, constituting Yin Deficiency with Fire Hyperactivity and Consumptive Disease. Thus Zhu Danxi proposed the theory of "Yang Excess and Yin Insufficiency," using Siwu Tang (Four Substances Decoction) added with Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) to tonify Yin, causing Fire to descend naturally. This uses Blood-tonifying herbs to supplement insufficient Blood. Tonifying Qi and Nourishing Yin are both internal injury syndromes. One lifts sunken Yang Qi; the other nourishes Yin to descend rising Yang Fire. One ascends, one descends; they are completely different.

There is also Summerheat injury in Summer. Although it is external contraction, it resembles internal injury and differs greatly from Shanghan. Cold injures the Form; Cold Pathogen lodges in the Exterior, an Excess syndrome, so sweating is indicated. Summerheat injures Qi; Original Qi is damaged by hot Qi, a depletion/insufficiency syndrome, so tonification is indicated. This is what Li Dongyuan meant by "Tonifying Qi and Clearing Summerheat."

There is also illness caused by consuming excessive cold items due to seasonal summer heat, injuring the interior; or seeking excessive cool wind, injuring the exterior. This is not Summerheat injuring people, but self-induced illness due to Summerheat. Treatment should use pungent-hot exterior-releasing or pungent-warm Middle-Jiao-regulating herbs, similar to Shanghan treatment methods.

All these syndromes appear similar externally but differ实质上. Treatments are diverse and must not be erroneous. External contraction vs. Internal injury, Cold disease vs. Heat disease, Qi deficiency vs. Blood deficiency are like ice and charcoal. If treatment errs, mild disease becomes severe, and severe disease leads to death. Must one not be cautious?

Zhang Jingyue stated: Yin deficiency with Yang hyperactivity, or simultaneous Yin and Yang deficiency, presenting with alternating chills and fever, stems from True Yin insufficiency and belongs generally to deficiency damage. However, the degree of Yin and Yang must be distinguished. Fever by day and quiet by night indicates Yang pathogen flourishing in Yang divisions, Yang excess. Quiet by day and fever by night indicates Yang pathogen sinking into Yin, Yin insufficiency. Fever and irritability both day and night, with excessive sweating, but not external contraction, though called Extreme Yang, is actually Extreme Yin deficiency. Loose stools or upper vomiting/nausea with tidal fever and night fever indicate Rootless Yuan Qi and Yang deficiency. Generally, Yang Excess requires draining Yang using bitter-cold; Yin Deficiency requires tonifying Yin using sweet-cool. For Yang Deficiency alone, even if there is fever, cooling herbs are strictly contraindicated; many fail to recognize this.

When Cold Pathogen suppresses meridians, causing chills and fever, resembling malaria but not quite, treatment should involve dispersing. However, if pathogen lingers long, it is due to Yuan Qi deficiency where Healthy Qi cannot overcome Pathogen. Thus, treatment must primarily tonify Qi and Blood. If chronic illness leads to great Yuan Qi deficiency with persistent chills and fever, only tonify Yuan Qi without dispersing. Observe Yin and Yang, choose accordingly. If truly Yang deficient, warming tonification is indispensable.

He also stated: Cold arising internally spreads from Zang organs to the exterior, causing shivering, aversion to cold, or cold limbs and spasms. Generally, Heat is mostly Excess, Cold is mostly Deficiency. Thus, treating Cold syndromes requires observing Deficiency and checking Zang organs; this is an unchanging method.