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All diseases fall into two categories: deficiency (Xu, 虚) and excess (Shi, 实). All prescriptions do not exceed two methods: tonification (Bu, 补) and purgation (Xie, 泻). However, the method of treating excess is relatively easy to understand and practice, so let us set it aside for now. It is only the method of treating deficiency that has been difficult since ancient times. As the world declines day by day, the primordial Qi (Yuanqi, 元气) becomes thinner day by day, deficiency diseases become more numerous, medical books become more abundant, yet treatment methods become more erroneous. Why? This is indeed due to the confusion between "disease manifesting as deficiency" (Bing Yin Si Xu, 因病似虚) and "deficiency causing disease" (Yin Xu Zhi Bing, 因虚致病). Let me discuss this.

What is meant by "disease manifesting as deficiency"? It refers to a person who originally had no other ailments, but either contracted the six excess pathogens (Liu Yin, 六淫), or suffered from dietary accumulation, or experienced emotional depression, or had Qi and blood stasis retention. This leads to mental confusion, dizziness and blurred vision, reluctance to speak, fatigue in movement, loss of taste in the mouth, sallow complexion, shortness of breath with a deep pulse, cold extremities, and diarrhea. Although various symptoms present a debilitated appearance, the pathogenic factors are internally constrained. Patients often fail to adhere to proper conduct and invariably consider themselves deficient, fearing attack therapies and cooling agents. Bystanders, relying solely on external appearances, invariably point out the deficiency and advise tonification. Doctors, failing to distinguish root and branch, often rely on old explanations of disease origin and readily administer tonifying formulas. Even those who are enlightened, knowing that the disease manifests as deficiency, may hesitate, fearing suspicion and ridicule, delaying time, and missing the optimal opportunity. Consequently, the pathogen becomes worse with tonification, and the accumulation becomes deeper. For emotional depression, there is no way to disperse it; for Qi and blood stasis, nourishing tonification makes it spread further. How can one know that this disease is not caused by deficiency? If the disease is not first removed, how can the deficiency be immediately treated? It is like a city wall falling into disrepair, allowing bandits to take advantage. Instead of driving them away, one busily builds higher walls and parapets. Ultimately, resources will be looted and houses burned, and the bandits will not stop until they break through the gates. What good does this do? Therefore, it is said: In "disease manifesting as deficiency," the disease is the root, and the deficiency is the branch. Treating the root resolves the branch. Rather than fearing deficiency and酿成 (brewing) an incurable disease, it is better to remove the disease and still have room for tonification later. If one uses the analogy of "nourishing righteousness causes evil to depart, and when gentlemen advance, petty men retreat," this discusses the scenario where significant deficiency coexists with excess. Regarding the inadvisability of tonifying "disease manifesting as deficiency," it is like teaching someone to sing in Qi while people from Chu interfere nearby; even if one administers the medicine of a gentleman, it turns into aiding the petty man.

What is meant by "deficiency causing disease"? It refers to a person whose innate constitution was always weak, and whose postnatal care was improper. Whether indulging in desires damages essence, or mental toil consumes spirit, or enduring cold, hunger, and labor, or acting on pride and enjoying luxury. Damage to essence affects the Kidney, which loses its function as the official of strength. Consumption of spirit affects the Heart, which loses its role as the sovereign. Cold form and cold drinks damage the Lung; irregular eating and labor damage the Spleen; these are common among the poor and lowly. Great anger causes Qi rebellion, damaging the Liver; rich wine and heavy flavors damage the Stomach; these are common among the wealthy. Once internal organs are damaged, external afflictions easily arise, leading to Yang deficiency with aversion to cold, Yin deficiency with aversion to heat, upper body asthma and fullness, distension of hypochondrium and abdomen, blockage of front and back (urination and defecation), restlessness and confusion, inability to eat, and a large pulse without root. Various signs and symptoms appear excess-like but originate from deficiency. Although muscles have not wasted away, the governing spirit is fading; even if daily activities are normal, the seeds of illness are latent. Yet, myriad complications arise, all rooted in one deficiency. At this moment when tonification should occur, patients and bystanders generate doubts, claiming external pathogens are not dispersed or internal accumulations are not cleared. Wanting to tonify Yin, they fear cold and cool herbs will damage the Spleen; wanting to tonify Yang, they fear dry and hot herbs will aid fire. Coupled with indecisive doctors who compromise and hope for accidental success, they fail to realize that this disease is entirely caused by deficiency! If one does not specifically treat the deficiency, how can one separately address the excess? It is like successive droughts and floods causing unemployment among the four occupations, leading to banditry. Unless one grants pardons during disasters and distributes grain to relieve poverty, but instead focuses on collecting taxes, the tax collection will never end, the bandits will not be pacified, and the primordial Qi will be further exhausted. Therefore, it is said: In "deficiency causing disease," deficiency is the root, and the disease is the branch. Treating the root resolves the branch. Rather than removing the disease and losing the ability to preserve deficiency, it is better to tonify deficiency so the disease can gradually be eliminated. If a doctor only knows that tonification is needed but fails to distinguish the reversal and correctness of Ying and Wei (Nutritive and Defensive Qi), Yin and Yang, then tonifying Yin for Yang deficiency is like adding water to depth; tonifying Yang for Yin deficiency is like adding fire to heat. This is applying the method for "disease manifesting as deficiency" erroneously to "deficiency causing disease." By distinguishing these two, treating deficiency becomes easy, and what worry is there about increasing medical books and erroneous treatments?