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When Yin prevails, Yang becomes diseased; when Yang prevails, Yin becomes diseased. When Yang prevails, there is heat; when Yin prevails, there is cold. Extreme cold transforms into heat, and extreme heat transforms into cold.
If Yang heat is hyperactive, the body will be feverish, the couli (skin pores) closed, breathing rapid and coarse, causing the patient to assume a prone or supine position due to dyspnea. Sweat cannot be excreted, leading to internal heat retention, dry teeth, mental restlessness and grievance. If abdominal fullness occurs, it indicates a fatal prognosis. The patient can tolerate winter but not summer. If Yin cold prevails, the body will be cold, sweating, often feeling chilly, with frequent shivering and cold sensations. Extreme cold leads to jue (cold extremities), and if jue is accompanied by abdominal fullness, it indicates a fatal prognosis. The patient can tolerate summer but not winter. (Excerpted from the *Suwen: Yingxiang Dalun* chapter.)

For any disease, palpation should be performed. ("Youguo" refers to having a disease.) A choppy pulse indicates excess Yang qi; a slippery pulse indicates excess Yin qi. Excess Yang qi... I believe that among severe diseases, none is more critical than this, as it resembles muscles being sliced by a knife, extremely dangerous and unsustainable for long. (From "Zhu youguozhe qie zhi" to "Wu han er shen han" are all excerpts from the *Suwen: Maiyao Jingwei Lun*. The two sentences regarding "Yin and Yang insufficiency" were supplemented by Shenzhai. Because this syndrome is extremely dangerous, it should not be ignored just because it is not mentioned in the classics. Therefore, it was supplemented and elaborated upon to clarify its significance.)

The classics state: Pathogens arising from the Yang aspect result from wind, rain, cold, and summer heat. It also states: Yang deficiency generates external cold. Yang receives qi from the upper jiao to warm the skin and muscle intervals. Now, if cold qi remains on the exterior, the upper jiao becomes obstructed. Obstruction of the upper jiao causes cold qi to remain solely on the exterior, resulting in chills. It also states: Yang excess generates external heat. If the upper jiao is not smooth, the skin becomes dense, the couli close, and the xuanguan (sweat pores) become blocked. Wei qi cannot diffuse outward, thus generating external heat. It also states: Pathogens arising from the Yin aspect result from dietary and lifestyle irregularities, as well as emotional fluctuations like joy and anger. It also states: Yin deficiency generates internal heat. Fatigue and overwork lead to depletion of form and qi, insufficient grain qi, failure of upper jiao function, and obstruction at the lower wan (lower stomach opening). Stomach qi stagnates and generates heat, which steams upward into the chest, causing internal heat. It also states: Yin excess generates internal cold. Jue qi rebels upward, and cold qi accumulates in the chest without being discharged. Lack of discharge causes warming qi to depart, leaving only cold. Blood then coagulates and flows sluggishly, blocking the vessels. The pulse becomes large and choppy, indicating internal cold.

Observe the complexion: yellow and red indicate excess heat; green and white indicate excess cold; black indicates blood deficiency and qi insufficiency. (Excerpted from the *Lingnu: Wuyin Wuwei Pian* chapter. The original text says "Green and white indicate less heat," but the current phrasing is superior, so it need not be changed.)

When examining floating collaterals, a blue color indicates cold and pain; red indicates heat. Cold in the stomach manifests as blue collaterals on the大鱼际 (thenar eminence); heat in the stomach manifests as red collaterals there. Sudden blackening indicates chronic bi syndrome. Presence of red, black, and blue indicates mixed cold and heat. Blue and short indicates qi deficiency. (Excerpted from... Floating collaterals that are mostly blue indicate pain; mostly black indicate bi; yellow and red indicate heat; mostly white indicate cold; seeing all five colors indicates mixed cold and heat. (Excerpted from the *Suwen: Pibu Lun* chapter.)

A rapid pulse indicates heat; a slow pulse indicates cold. All Yang pulses indicate heat; all Yin pulses indicate cold.

A renying pulse (carotid artery) that is vigorous indicates heat; deficient indicates cold. A qikou pulse (radial artery) that is vigorous indicates abdominal fullness and cold in the middle with inability to transform heat. A deficient qikou pulse indicates heat in the middle, oral ulcers, qi deficiency, and changes in urine color. (Excerpted from the *Lingnu: Jinfu Pian* chapter.)

Qibo said: Treat cold with heat, treat heat with cold. For mild conditions, use contrary treatment (Zhengzhi); for excessive conditions, use following treatment (Fanzhi). The Emperor asked: What do contrary and following mean? Qibo said: Contrary is standard treatment; following is reverse treatment. Depending on the severity, observe the situation. The Emperor asked: What is reverse treatment? Qibo said: Heat used with cold properties, cold used with heat properties, obstruction treated with obstruction, diarrhea treated with purgation. One must subdue the main pathogen and address the root cause. Initially, the treatment may seem similar to the pathology, but ultimately, it differs. It can break up accumulations, dissipate hardness, harmonize qi and blood, and ensure recovery. (Excerpted from the *Suwen: Zhi Zhen Yao Da Lun* chapter.)

For mild conditions, regulate them; for moderate conditions, level them; for excessive conditions, drain them. Use sweating or purging methods. Utilize cold, heat, warm, and cool properties to attenuate based on the affected organ, following what is beneficial. For mild cold, use warm harmonizing agents; for severe cold, use hot resolving agents; for extreme cold, use purgative draining. If draining fails, use opposing measures. If opposing measures fail, seek the root element to attenuate it. For mild heat, use cool harmonizing agents; for severe heat, use cold resolving agents; for extreme heat, use sweating dispersants. If dispersal fails, use opposing constraints. If constraint fails, seek the root element to attenuate it. (The twenty-eight characters starting from "Wei zhe tiao zhi" are also from the *Zhi Zhen Yao Da Lun*; the eighty-eight characters starting from "Jia ru xiao han" are annotations by Qiyuanzi.)

Yang excess and Yin deficiency are cured by purgation but killed by sweating; this is a heat syndrome. Yang excess generates external heat; Yin deficiency generates internal heat. Purgation uses cold medicines to clear heat, as cold nature tends downward.

Yin excess and Yang deficiency are cured by sweating but killed by purgation; this is a cold syndrome. Yang excess generates internal cold (Note: Text logic implies Yin excess generates internal cold, Yang deficiency generates external cold, but translating literally as per source); Yang deficiency generates external cold. Sweating here uses hot medicines to warm, not true sweating, but rather using medicine to assist rising, floating, and growing qi to support Yang.

The Emperor asked: Discussions say treat heat with cold and cold with heat, and physicians cannot abandon rules. Yet some heat patients become hotter after taking cold medicine, and some cold patients become colder after taking hot medicine. Both occur, and new diseases arise. What should be done? Qibo said: For those whose heat persists despite cold treatment, tonify Yin. For those whose cold persists despite hot treatment, tonify Yang. This is seeking the root attribute. It is essentially boosting the source of fire to eliminate Yin shadows, and strengthening the master of water to control Yang brilliance.

The Emperor asked: Why does taking cold medicine cause heat, and taking hot medicine cause cold? Qibo said: Treating only the flourishing pathogenic qi leads to this reaction. The Emperor asked: Why does it happen even without treating the flourishing qi? Qibo said: You ask profoundly! It is due to ignoring the attributes of the Five Flavors. Each flavor enters the stomach and goes to its preferred organ: sour to Liver, bitter to Heart, sweet to Spleen, pungent to Lung, salty to Kidney. Long-term intake increases the qi of that organ, which is normal transformation. However, prolonged increase leads to premature death. (Above is from *Zhi Zhen Yao Da Lun*; below is Qiyuanzi's annotation.) Sour enters Liver as warm, Lung as clear, Heart as hot, Kidney as cold, Spleen as supreme Yin, combining four seasons. All increase flavor to benefit qi. Thus, long-term use of Huanglian or Kushen may cause heat. Hence, long-term intake increases qi, which is normal. But prolonged increase leads to organ qi excess; excess leads to exclusion; exclusion leads to sudden death. Hence, prolonged increase is the cause of early death.

Question: Why does cold not retreat with hot medicine, and heat not retreat with cold medicine? Answer: Heat failing to respond to cold indicates lack of Water (Yin); cold failing to respond to heat indicates lack of Fire (Yang). Failure to cool cold is blamed on lack of Water; failure to warm heat is blamed on lack of Fire. The classics say: Nourish the source of transformation. If the source is exhausted, how can medicinal imitation nourish the true Water and Fire? (From *Zhi Zhen Yao Da Lun*.) The Emperor asked: What if the pulse follows the disease but symptoms contradict? Qibo said: The pulse seems to follow, but upon pressure, it does not throb; this applies to all Yang pulses. (Qiyuanzi notes: Fever with rapid pulse but non-throbbing upon pressure indicates Yin excess repelling Yang, not true heat. This section describes Yang syndromes where the pulse follows the symptom, appearing hot but presenting cold signs. All Yang pulses show rapidity without throbbing, reflecting Sun Taiyang's different root and branch.) (Also *Zhi Zhen Yao Da Lun* says:) The Emperor asked: What about Yin pulse reversals? Qibo said: The pulse seems to follow, but upon pressure, it beats vigorously and strongly. (Qiyuanzi notes: Cold signs with strong pulsation under pressure indicate Heat excess repelling Yin, not true cold. This section describes Yin syndromes where the pulse follows the symptom, appearing cold but actually being heat. Thus, diseases originate from root, branch, or intermediate qi. Treatment can target root, branch, or intermediate. Contrary treatment is actually correct; following treatment is actually contrary. Knowing root and branch ensures safety; knowing correct and contrary ensures precise action. Ignorance confuses meridians. Thus, crude physicians laugh, thinking they know, confusing heat and cold, mixing similar Qi with different forms, disrupting diagnosis. The way of root and branch is concise yet comprehensive, small yet great. Speaking of root and branch prevents harm. Observing root and branch harmonizes Qi. Knowing overcoming and returning sets an example for all people, completing the Way of Heaven. (From "Bai bing zhi qi" onwards is from *Zhi Zhen Yao Da Lun*.) Among Six Qi diseases, Sun Taiyang and Shao Yin have the most contradictory root and branch. Sun Taiyang has Heat branch and Cold root; Shao Yin has Cold branch and Heat root. Qiyuanzi explains Yang pulse following as heat disease (Taiyang branch); non-throbbing pressure indicates Yin excess repelling Yang (Cold water root, opposite to branch). Yin pulse following as cold signs (Shao Yin branch); strong throbbing pressure indicates Heat excess repelling Yin (Minister Fire root, opposite to branch). Thus, ignoring contradiction and treating branch oppositely with standard methods follows root cold/heat, leaving disease unchanged. Outwardly seeming compliant, inwardly rebellious, making prescriptions seemingly compliant but actually contrary. Knowing contradiction, treating branch oppositely with reverse methods opposes root cold/heat, leading to cure. Outwardly contrary, inwardly compliant. This seems contrary but is actually correct. Knowing root and branch ensures safety; knowing correct and contrary ensures precision. If pulse follows disease but symptoms reverse: Yang-like symptoms with Yang-like pulse but actual cold; Yin-like symptoms with Yin-like pulse but actual heat. Thus, treat opposite to pulse and symptom. (Below details treatment for pulse-symptom mismatch, advocating discarding symptoms for pulse. However, sometimes pulse and symptom match but disease truth is opposite, requiring reversing treatment based on symptom/pulse. This clarifies infinite disease mechanisms, urging careful examination.) For example, fever, irritability, red face, but deep, faint pulse indicates Yin syndrome mimicking Yang. Fever is due to interior cold; irritability due to Yin excess; red face is Dai Yang (floating Yang) due to lower deficiency. If doctors ignore pulse and mistake for excess heat, using cold/cool drugs destroys Qi and causes major illness. *Waitai Mi Yao* says: Yin excess causing agitation, wanting to sit in a well, should be treated with hot medicine. Zhang Zhongjing treats Shao Yin red face with Sini Tang plus Congbai to counteract Yang. If cold drugs enter, fire rises with water, extreme Yin agitation makes one want to sit in a well. Doctors failing to recognize Yin syndrome as heat and administering cold drugs inevitably cause death. Vomiting or coughing causing agitation, steaming fever, wanting to remove clothes near cold, or drinking cold water causing chills, shortness of breath, chest fullness, open mouth, staring eyes, loud voice, tears/snot/phlegm, brief agitation. Six pulses deep, fine, choppy, empty upon pressure indicate extreme cold. Sweet-warm pungent formulas cure it. *Huo Ren Shu*: Cold limbs, constipation, red urine, or black stool, deep slippery pulse indicates Yang syndrome mimicking Yin. Mild cases use Baihu Tang; severe cases use Chengqi Tang. Typhoid missed by purgation causes blood/qi blockage and cold limbs (latent heat). Deep jue requires rapid Da Chengqi Tang purgation; sweating cures it. Heat jue is mild, fever follows jue; Yin jue has no fever, cold limbs, aversion to cold, deep fine pulse, loose stools.

These two sections discuss Yang-like symptoms with Yin disease, and Yin-like symptoms with Yang disease, hence treating opposite to symptoms. While Yang-like/Yin-disease and Yin-like/Yang-disease are distinguishable, Pulse-Symptom both Yin with Yang disease, and Pulse-Symptom both Yang with Yin disease are universally indistinguishable. Xu Xueshi recounts Zou Shoudi’s nephew with typhoid,烦渴 (irritability/thirst) and sweating, treated with cool drugs, becoming Yin Du (Yin toxin) and dying. Zou wrote "Yin Du Formulas." This laments the world. Sun Taiyang Bladder meridian uses Heat due to Cold application. Bladder root is cold, meridian name is Taiyang. Branch is heat, Root is cold. Pulse tight/rapid, non-throbbing/empty indicates false Yang outside, true cold inside. Zhongjing uses Ginger/Aconite boiled long, served cold. Ginger/Aconite are Yang; long boiling extracts heavy Yang heat to purge pure Yin cold (treating root). Serving cold uses fake cold to treat Taiyang branch fake Yang, a method of opposing truth/falsehood. Physicians must know empty pulse indicates hidden Yin cold showing heat signs (thirst, red eyes/mouth/face, hot limbs). This is floating Yang ending externally, rejected by internal cold. Hand Shao Yin Heart meridian uses Cold due to Heat application. Shao Yin meridian true Yin, Heart root is true Fire. Shao Yin branch Yin, root Heat. Inside Yang is root, outside True Yin is branch. Pulse deep/fine, throbbing/huge/tight/strong upon pressure indicates Heart Fire inside (tight/huge) and True Yin branch (deep/fine, Water nature). Zhongjing uses Da Chengqi Tang hot to remove branch cold, using Dahuang/Mangxiao bitter/salty/cold to purge root heat. This is eternal method. Treating heat with cold, administered warm.

Classics say: Treat heat with cold, administer warm. Three meanings: 1. Severe heat uses Renshen, Huangqi, Gancao (sweet/warm). Though内外皆热 (heat inside/outside), internal irritability and external skin heat are harmonized by sweet/warm, inducing sweat and cure. Sweet/warm treats severe heat. 2. Extreme heat generates wind; Earth moves left, Mother strengthens Child, Heaven moves right順行 (smoothly). Diseases heal with Heaven's command. 3. External heat hides internal cold. Warmth dispels cold, aiding Earth Qi (Stomach vital Qi). Making vital Qi robust. Classics say: Treat cold with heat, administer cool. Zhongjing treats Shao Yin diarrhea with weak pulse using Baitong Tang. If diarrhea persists, jue, no pulse, dry heaves, irritability, add Pig Bile. Treating cold with heat, using bile to administer cool. Three meanings: 1. Northerners injured by extreme cold have swollen calves (cold wins causing float). Moxa/bath causes skin loss/bone exposure. First wash with fresh water to restore. Frozen face/ears: fire/bath causes sores. First wash with cool water, then warm compress restores. Cool administration removes extreme cold. 2. Extreme cold strengthens Mother (Earth/Lung), moving left against Heaven. Cool drugs make Heaven move right smoothly, healing diseases. 3. External extreme cold hides extreme heat in Nine Earths (Sanjiao/Pericardium, root of Tianzhen Qi). Heat inside damages Yuan Qi (Stomach). Cool drugs harmonize Yuan Qi, preventing damage. Classics: Aversion to cold/shivering belongs to heat. Shivering losing spiritual control belongs to fire. Even in summer, wind/rain/heavy clothes cause shivering. *Yuan Bing Shi* says: Hot symptoms feeling cold are heat diseases, not cold. Some ask: Why do hot medicines cure? Heat patients' Qi flares up, condensing into phlegm-fluid, blocking clear pathways, Yin not rising, heat worsening. Phlegm temporarily retreats with heat, but heat aids evil, deepening disease. Some ask: Who dares use cold drugs for such cold? Answer: Ancients cured shivering with Da Chengqi Tang purging dry stool. Shivering is clearly heat, differing in deficiency/excess.

Classics: Yin deficiency causes fever. Yang outside guards Yin; Yin inside guards Yang. Spirit wanders, desires uncontrolled, Yin dissipates, Yang has no attachment, floating on surface causing fever. Not true heat, treat as Yin deficiency with Yin tonification. Some ask: Typhoid fever is all pathogenic? Answer: Typhoid heat enters from outside; Yin deficiency fever emerges from inside. Stagnant Fire heat depends on meridian. Mild cases descend; severe cases ascend according to nature.

Excess Fire descends; urination descends fire quickly. Tonifying Yin descends fire naturally. Use Chao Huangbo, Sheng Dihuang.

Deficient Fire tonifies; Renshen, Baizhu, sweet to缓 (slow/relax). Any excess Qi is Fire. Urgent cases require缓 (slowing); raw Gancao slows. Fire excess cannot suddenly use cold/cool; must combine warm to disperse. Zuojin Wan treats fire: Chuanlian 6 liang, assisted by Wuzhuyu 1 liang.

Yin deficiency with Fire movement: Untreatable.

Case Study

Danxi treated a pale woman with aversion to cold using Bazhen Tang minus Chuanxiong, plus Chao Huangbo. Condition worsened. He realized deep heat lacked anti-assistant (fan zuo) measure. Used previous herbs roasted, cured her. Treating heat with cold, borrowing Fire power, administered warm.

One patient with alternating cold/heat, night sweats, fatigue, poor appetite. Six pulses wiry, Chi larger than Cun, Xin area more deficient. Said: Liver/Spleen/Stomach deficiency. Stomach Qi cannot reach Liver, Liver Wood carries evil to attack Spleen Earth. Liver strong, pulse wiry. Wiry means reduction, meaning less neutral Qi. Deficiency in Spleen, Spleen should be supported. But supporting Spleen without controlling Wood is useless. Wood has deficiency/excess. Yin's growth is Yang's death; Yang's growth is Yin's death. Gallbladder is Jia Wood, born in Hai, Liver is Yi Wood, dies in Hai. Deficiency in Wood's Yin, excess in Wood's Yang. Qi excess, Blood deficiency. Heart governs Blood, Xin pulse deficient, Blood insufficient, Yang sinks, Chi pulse large. Method should...