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The *Yellow Emperor's Inner Canon* states: Diseases have favorable (conforming) and unfavorable (contrary) courses, due to the slightness or severity of the disease; the slightness or severity of the disease is determined by the truth or falsity of the symptoms. If one does not understand the truth or falsity of cold and heat, errors in treatment will occur. For true conditions, direct treatment (Zheng Zhi, treating cold with heat and heat with cold) is applied; for those who understand this, it is not difficult. For false conditions, contrary treatment (Fan Zhi, such as treating heat with heat or cold with cold) is required, which is the difficult part.

Regarding the truth or falsity of cold and heat: A true cold condition presents with a deep and fine pulse, or weak and slow, accompanied by cold extremities (Jue Ni), vomiting, abdominal pain, undigested food diarrhea (Sun Xie), loose stools, and frequent urination. Even if fever is present, the patient desires to wear clothes; this indicates floating heat on the exterior and sinking cold in the interior. A true heat condition presents with a rapid and forceful pulse, slippery, large, and excess; accompanied by restlessness, panting, and chest fullness, loud and harsh voice, constipation, or dark and scanty urine, or fever where the patient throws off covers, or distending pain and thirst for cold drinks. These are all true diseases. True cold should be treated with warming methods to dispel cold; true heat should be treated with clearing methods to resolve heat. This is direct treatment.

As for false cold, it is extreme fire resembling water, where Yang conditions resemble Yin. Although the exterior feels cold, the interior is hot. The pulse is rapid and forceful, or deep but beating strongly like a drum, or the body dislikes clothing, or stool is hot and constipated, or there is irritability and thirst with desire to drink, or intestinal discharge is foul-smelling. This is aversion to cold that is not true cold, clearly a heat condition. It is called "extreme heat assuming cold transformation" or "Yang excess repelling Yin."

False heat is extreme water resembling fire, where Yin conditions resemble Yang. Although the exterior feels hot, the interior is cold. The pulse is faint and weak, or rapid but empty, or floating and large without root, or wiry, knotted, intermittent. The body may be burning hot but the spirit and expression remain calm; speech may be delirious but the voice is weak; or there is false mania and tumbling that stops when restrained; or skin lesions resemble mosquito bites with small, fragmented red spots; or there is a preference for cold water but little is drunk; or the tongue surface is red but the patient keeps warm clothing/bedding on; or there is frequent urination but no constipation. This is aversion to heat that is not true heat, clearly a cold condition. It is called "extreme cold assuming heat transformation" or "Yin excess repelling Yang." These are false diseases and false cold. For false cold, clear the internal heat; once the internal heat is cleared, the floating Yin will depart. For false heat, warm the true Yang; once the middle warmer is warmed, the deficient fire will return to its origin. This is contrary treatment (Cong Zhi).

Similarly, regarding deficient heat and excess heat: Excess is purged, deficiency is tonified. This is an unchangeable principle. However, extreme deficiency may present with excess signs, which is false excess; extreme excess may present with emaciated signs, which is false deficiency. In summary, deficiency refers to the deficiency of Zheng Qi (Upright Qi), manifesting as a gloomy complexion and emaciated form, mental fatigue and timid qi, spontaneous sweating that does not stop, incontinence of urine and feces, nocturnal emission and seminal leakage, vomiting and diaphragmatic obstruction, excessive purgation during long-term illness, shortness of breath resembling asthma, overexertion, or sudden exhaustion and loss of will. Although external signs may resemble excess, if the pulse is weak and lacks spirit, these are all deficiency conditions requiring tonification. Excess refers to the excess of Xie Qi (Pathogenic Factors), whether blocking meridians externally or knotting in organs internally, or qi stagnation and blood stasis. Only when both pulse and disease signs are robust is it an excess condition requiring attack/purging.

However, between deficiency and excess, there is much ambiguity, making it essential to distinguish the truth. As the Canon states: "When pathogenic factors are abundant, it is excess; when essence and qi are depleted, it is deficiency." This is the general rule for deficiency and excess. Suppose a person whose Zheng Qi has been depleted while Xie Qi is currently abundant: Should one protect the Zheng Qi and tonify first? Or should one attack the Xie Qi first? If the judgment is not accurate, life and death depend on it; thus, caution is necessary. Zheng Qi is the root; Xie Qi is the branch. If Zheng Qi is already deficient, even if Xie Qi is abundant, one must not attack, for fear that the Xie Qi will not be expelled before the Zheng Qi collapses, leading to fatal changes in breathing that cannot be managed. Therefore, in treating mixed deficiency and excess, one must first protect the Zheng Qi. If Zheng Qi is preserved, harm will not occur. Moreover, tonification contains the intent of purging; there is no case where Zheng Qi recovers while Xie Qi remains. This is the method for treating deficiency. If Zheng Qi is undamaged, even if Xie Qi is slight, one should not tonify, for tonification would leave Zheng Qi unsupported and allow Xie Qi to flourish, effectively lending weapons to bandits and grain to thieves. Therefore, in treating excess conditions, one must directly remove the Xie Qi; once removed, the body is at peace. The method must be precise and focused to achieve rapid results. This is the method for treating excess. Ultimately, those who can withstand attack are excess conditions; those who cannot are deficiency conditions. False deficiency conditions are rare, while false excess conditions are most common; false cold conditions are not difficult to treat, but false heat conditions are often mistreated. I dare not lightly endorse those in the world who claim to know medicine without understanding the root and branches of truth and falsity.