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The totality of the Dao is undifferentiated; no one knows its source. Once the Dao differentiates, changes are infinite and endless; no one can know its beginning. Inferring from these changes, when it condenses into substance, it is named by the Five Elements (Wu Xing); when it transforms into Qi (vital energy), it is governed by the Five Movements (Wu Yun). It gathers to become a human being, corresponding to the Zang-Fu organs (Five Viscera). From then on, the names of things, the deduction of numbers, and the exhaustion of principles allow the traces of the Dao to be spoken of. From the great Heaven and Earth to the small individual body, the principles may all be the same. Summarizing them, the key lies in proper nourishment without error.

Therefore, if clouds and mist are not pure, they will fail to correspond to the upper level, causing White Dew (Bai Lu) not to descend. If White Dew does not descend, plants and trees cannot flourish. Consequently, treacherous winds blow frequently, heavy rains fall often, and the four seasons of Heaven and Earth cannot maintain each other. This is akin to the weather failing to succeed one another and the Dao losing its connection. Human daily life deviates from propriety, and nourishment loses its measure. One Zang organ has excess, another has deficiency; Cold and Warmth cannot interact, Ying (Nutritive Qi) and Wei (Defensive Qi) cannot communicate. Wind Qi enters through gaps, and diseases arrive as swiftly as flying arrows. Strange and severe diseases occur as easily as turning a palm. This demonstrates that the principle connecting Heaven and Earth with humans is never different.

Ancient sages harmonized with Yin and Yang, adjusted to the Four Seasons, nourished Yang in Spring and Summer, and nourished Yin in Autumn and Winter. They floated and sank with all things within the gate of growth. Thus, their bodies had no strange diseases, and their lifespan could rival Heaven and Earth, having no end. There is no other reason than that their nourishment was without error, so their vital Qi did not exhaust. The wise person models the head after Heaven for nourishment, the feet after Earth, and the middle after human affairs to nourish the Zang-Fu organs without error. They can also extend their lifespan to a definite limit. As for common people, unable to follow the laws of Heaven and the principles of Earth, they err in their nourishment. Heavenly pathogenic factors invade and harm the Zang organs; cold and heat from food and drink invade and injure the Fu organs; dampness from the earth invades and harms the skin, flesh, sinews, and vessels. Hundred diseases arise without cause from this point.

Once a disease arises, it undergoes thousands of transformations, impossible to fully investigate. Therefore, skilled physicians do not worry about the difficulty of treating diseases, but rather the difficulty of recognizing them and the difficulty of administering medicines. Why? Because the depth of the disease varies, and the weight of the medicine differs. Measuring the depth requires precision down to a hair's breadth; clarifying the weight allows no deviation of a grain. Between depth and weight lies the distinction between a physician's skill and clumsiness, and the life or death of the patient. In the balance of gain and loss, lives are determined; thus, the medical art is necessarily difficult.

Therefore, a skilled physician, upon encountering a disease, must first examine its root origin, determine its transmission, assess its overcoming relationships, distinguish its cold, cool, warm, and hot nature, and differentiate its upper/lower and internal/external locations. Some are true pathogens, some are deficiency, some are excess. Sometimes there is blockage and stagnation; sometimes there is emptiness and weakness with loss of control. Treatment may involve acupuncture, moxibustion, purgation, or diaphoresis. For what is not mastered, leave it blank; for what must be verified, act bravely. Formulation has a sequence of priority; selection has degrees of weight. Principles are clear, each having its norm, allowing no hair's breadth of error.

Diseases originate from a root, follow a transmission, and involve overcoming relationships. These are unusual syndromes and signs of labor injury. Labor injury begins with the deficiency of the Dan Yuan (Elixir Field) and Marrow Sea. Thus, true diseases always start in the Kidney. Water overcomes Fire, so it transmits to the Heart; Fire overcomes Metal, so it transmits to the Lung; Metal overcomes Wood, so it transmits to the Liver; Wood overcomes Earth, so it transmits to the Spleen. The five Zang organs transmit to each other, five Qi extinguish each other, five Spirits dissipate, Ying blood becomes stagnant, and Wei Qi departs. The treatment of Jing Shen (Spirit) and Ying-Wei originates in the Kidney. Before transmission reaches the Heart, if one administers medicine for Kidney pathology, the Qi naturally damages itself. One should treat the Kidney before it transmits to the Heart, attacking the "ghost" (pathogen) and cutting off the root. Then treat the Heart to drive out evil and protect Heart Qi. When transmitting to the Lung, symptoms include sticky saliva and phlegm, wheezing, and coughing. Treat the Heart first to attack the evil and cut off the transmission trend. Once Fire evil is extinguished, even before Lung medicine is administered, most wheezing and coughing will cease. Then treat the Lung to resolve evil and protect Metal Qi. Finally, treat the Kidney to clear the organ and restore True Qi. If left untreated until it transmits to the Liver, resulting in flaccidity and bi-syndrome where the patient is bedridden, treatment is futile. This process involves examining the root, determining transmission, and assessing overcoming relationships.

If the five Zang organs are warm and mild, where do diseases come from? Improper nourishment leads to pathological changes. Although hundred diseases arise with thousands of transformations, their ultimate歸归 (return) is limited to Cold, Heat, Warmth, and Coolness. Cold should not be treated with Warmth; this is called "Insufficiency." Treating Coolness with Heat is called "Excess." Insufficiency means the disease cannot be eliminated; Excess means it damages True Qi. Cold is treated with Heat; Chill is treated with Warmth. With appropriate weight and controlled speed, without the slightest error, the treated disease is completely cured. This is distinguishing Cold, Heat, Warmth, and Coolness.

It is said: When fierce winds enter the forest, dry branches break first; when heavy rain breaks the dam, cracks fail first. Thus, the Eight Evils (Pathogens) infect humans by entering through gaps. Diseases must be distinguished by internal/external and upper/lower. Wheezing, coughing, solid phlegm in the chest, tidal saliva, endangering life—these are diseases in the Upper Jiao. Flaccid legs and knees, weak walking, heavy waist and hips—these are diseases in the Lower Jiao. Arising from skin and hair, affecting sinews and bones, sudden cold invasion, indigestion, sudden heat toxin attack, constipation—these vary by cold/heat and are diseases in the Interior.

For diseases in the Upper, use emesis to bring peace; if emesis is contraindicated, use slow regulation. For diseases in the Lower, use tonification to heal; if tonification is contraindicated, use rapid regulation. For diseases in the Exterior, use acupuncture, moxibustion, or sweating according to suitability. For diseases in the Interior, use attack, tonification, or purgation according to cold/heat. With methods for treatment and rules for differentiation, why worry about the lack of efficacy of prescribed medicines? This is distinguishing upper/lower and internal/external.

Five flavors please the mouth, five colors blind the eyes. Endless desires, unceasing greed, and recurring worries damage Jing Shen (Spirit) and destroy the root. Humans inevitably have Deficiency and Excess. Excess is surplus; Deficiency is lack. Surplus is drained; lack is tonified. Within tonification and drainage, there is further distinction between internal and external. For form deficiency, warm with Qi; for essence deficiency, tonify with Flavor. Inside the Zang-Fu organs, excess is cleared with herbs; outside in the limbs and joints, excess is drained with acupuncture and stone needles. This is the difference in tonification and drainage, i.e., distinguishing Deficiency and Excess.

Ancient people lived past a hundred years without physical decline. Modern people decline before fifty. This is not because Heaven favors ancients and punishes moderns. Ancients knew the art of nourishment; desires did not tire their eyes, licentiousness did not confuse their minds. Blood and Qi were harmonious, Spirit was preserved internally, so they lived past a hundred without decline. Their True Essence was intact, and pathogens could not overcome them. Modern people do not know the art of nourishment; they pursue mental pleasure against the joy of life. Blood and Qi wither, Spirit dissipates. Disease is passed from generation to generation. Qi is deficient, body is emaciated. Within breaths, hundred diseases gather in the Zang-Fu organs. This is due to Jing deficiency and Shen lack, allowing external pathogens to interfere with Yin-Yang Zheng Qi (Upright Qi).

Skilled physicians preserve True Essence and eliminate pathogens, ensuring excessive medicines do not harm True Essence. This is distinguishing True vs. Pathogenic. Even blockage, emptiness, and weakness are known even to children. Internal diseases are treated with herbs; external diseases with acupuncture. For urgent conditions where herbal efficacy is slow, consider cases where moxibustion is indicated. For example, Yin-Du Cold Damage (Yin Toxin Cold Injury) presents with cold limbs, blue face, black lips, and unconsciousness. Urgently apply moxibustion to Qihai (CV6). Ten-plus moxa cones restore Spirit and Qi. In summer, cooling excessively, drinking cold water, indulging in sex leads to extreme Jing deficiency and strong Yin evil. Yin-Yang struggle, Yin prevails, guarding the lower origin. Yang is weak, attacking the head and neck. Feet are cold as snow, limbs cold, pulse deep. Only intense heat and unbearable pain remain. Acupuncture is useless here; urgently moxa Qihai. Dozens of cones cause cold drinks to pass downward, limbs warm up, and Yin-Yang reconnect. For cold-hot abscesses, red/painful or hard/painless, apply wet paper to find the first dry spot and moxa. Up to 100+ cones. For cold swelling without dry spots, moxa the center of the swelling up to 100 cones, adjusting based on body thickness. If moxa causes no pain, stop when pain is felt. After consuming Realgar (or similar mineral drugs like Sulfur), caution is needed.

For diseases treatable by sweating, purging, acupuncture, or moxibustion, order and weight must be correct. Why worry about non-recovery? Alas! Heaven and Earth have no perfect function; Sages have no omnipotence. Even Huangdi and Qibo acknowledged untreatable diseases. If a condition is unusual, unclear, or unknown, leave it untreated without shame. If the disease is severe and the patient critical, and the physician understands the principle and details, they must not hesitate. Use toxic drugs and verify with acupuncture to save life from death. This requires divine wisdom; fools doing so are like murderers wielding knives. This is leaving blanks for ignorance and acting bravely for verification. Rules must not be violated.

Some diseases do not follow Five Element transmission. Cold congestion interacting, Yin-Yang hiding, appearing hot but actually cold, appearing cold but actually hot, two colds and two heats attacking, excess and deficiency hindering each other. These create major suffering. Example: Lung has excess heat, but exposure to wind/rain/cold causes Cold Evil to lodge in the Lung Meridian. Cold and Heat interact causing cough. Cooling herbs aid Cold; warming herbs aggravate Heat. Neither works. Formula: Qiang Huo (Notopterygii Rhizoma et Radix), Huang Ju Pi (Citri Reticulatae Pericarpium), Ma Huang (Ephedrae Herba - remove roots), Zi Wan (Asteris Radix), Xing Ren (Armeniacae Semen Amarum - remove skins/tips), Xi Xin (Asari Radix), Du Huo (Angelicae Pubescentis Radix), Fang Feng (Saposhnikoviae Radix), Jie Geng (Platycodonis Radix). Powder form, 2 qian per dose, mixed with boiling water, taken on an empty stomach. Cough stops in a few doses. This lightly resolves Cold Evil, using the empty stomach to guide Cold Qi out via the Stomach. This treats Cold-Heat interaction.

Another case: Fundamental excess heat in Zang-Fu, exposed to summer heat, suddenly entering cool places, drinking cold water. Cold wins, fearing Heat. Yin-Yang hide. Yin solidifies, Yang stagnates. A lump forms in the chest, named "Fu Shu" (Hidden Summerheat). Symptoms: chills, irritability, resembling Cold Damage but pulse not rapid. Physicians wrongly use purgatives, exhausting Fu essence, making the chest lump harder. Purgatives aided Cold/Yin. Treatment: Chuan Xiong (Ligustici Chuanxiong Rhizoma), Xi Xin (Asari Radix), Huo Xiang (Agastaches Herba), Huang Ju Pi (Citri Reticulatae Pericarpium). Powder, 2 qian, decocted in one cup of water to 70%. Taken on an empty stomach. Resolves Cold Qi; the lump dissipates quickly. Then check pulse, assess Summerheat toxicity, and prescribe accordingly. This treats Yin-Yang hiding.

Diseases appearing hot but actually cold: Postpartum syndrome. Five Zang accumulate cold, Yin prevails. Milk flows excessively without cause. Dry mouth/throat, thirst at irregular times, dizziness, reduced appetite, empty intestines/stomach, emaciation. Desire to defecate but inability to do so. Inexperienced physicians see dry mouth/thirst as Upper Jiao Heat; dizziness as Blood Heat generating Wind; constipation as Large Intestine dryness. They miss that excessive milk flow indicates dryness/heat from deficiency; dizziness/emaciation indicates Qi/Blood deficiency and insufficient transport. Misdiagnosing as Heat and giving Cold herbs kills instantly.

Diseases appearing cold but actually hot: Strong men indulging in lust, taking tonic herbs, seeking sexual pleasure while confused. Heat herbs attack, Ying-Wei stagnate. Upper Qi excess, Lower Qi deficiency. Qi does not connect. Legs/knees weak, feet cold, occasional chills, dark/emaciated body, reduced appetite, nausea with salty food. Physicians diagnose Zang-Fu deficiency and give Warming herbs, like adding wood to fire. Instead, use Cooling herbs to benefit the Lung, scatter toxic heat rising. Once Ying-Wei circulate, Yin-Yang reconnect, hands/feet warm, legs recover. This is appearing cold but actually hot.

Year of Excess Yang brings drought; Year of Excess Yin brings floods. Deficiency generates Cold, Excess generates Heat. Zang-Fu experience conflicting Cold and Heat. Yang Du (Yang Toxin) in Cold Damage is an example. Lust destroys life foundation. People, deluded, take toxic heat herbs hoping for survival. Dan Yuan/Marrow Sea empty, yet Zang-Fu bone cavities have increasing deficiency heat. Excess and deficiency hinder each other. Example: Constipation (5-10 days), frequent urination (50-60 times/day), small amount of urine, clear as water but sometimes yellow, painful urination, irritability. This is Liver/Heart/Spleen/Lung Toxic Heat Excess, while Kidney/Small Intestine Qi is deficient. Spleen/Lung/Heart heat causes dry intestines; Kidney/Small Intestine deficiency causes slippery waterways. Liver/Heart heat causes boiling blood/dark blood. Toxic heat smoke settles in Middle Jiao. Due to Small Intestine deficiency, water flows only through the Small Intestine. Urine is clear but painful, resembling Lin Syndrome (Strangury) but is not. Physicians giving Warming herbs to secure Small Intestine nourish Liver/Heart heat, worsening pain. Giving Cooling herbs to purge Large Intestine sends medicine only through the Small Intestine, worsening disease. Cold/Hot herbs both fail due to Excess/Deficiency hindrance.

Treatment: Use Qi-moving decoction to wash the anus (Gu Dao). Guide Zang Qi to Stomach. Second time, induce bowel movement, moving gas/feces to Large Intestine, remaining water follows. Urination stops without Small Intestine medicine. Gradually use medicine to open Liver/Heart, expel toxic heat via stool. Stool resembles half-rotten matter/blood stasis. Root is reduced. Medicines are in the formula. This treats Excess/Deficiency hindrance.

Alas! Medical arts are like a forest; my knowledge is but a sprout. Medical Dao is like the sea; my knowledge is but a drop. Though I have little merit, my effort is sincere, unlike mere words of ancients. I list a few points to clarify the general outline of the medical Dao.