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The author of *Wen Yi Lun* (Treatise on Pestilential Fevers) posited that epidemic pathogens generally reside in the Mo Yuan (Membrane Source, a location between the exterior and interior), and therefore specifically utilized Da Yuan Yin (Reach the Origin Decoction) along with heavy doses of Rhubarb. This was indeed a unique insight. Occasionally, it could cure the disease, but...

Since Zhang Zhongjing, those discussing treatment have known to distinguish between Exterior (Biao) and Interior (Li) syndromes. The Foot-Taiyang Bladder Meridian is the Exterior within the Exterior; the Foot-Yangming Stomach Meridian is the Interior within the Exterior; the Foot-Shaoyang Gallbladder Meridian is the Half-Exterior Half-Interior. From this deduction, the Three Yin meridians (Taiyin Spleen, Shaoyin Kidney, Jueyin Liver) all belong to the Interior. This has almost become an unchangeable doctrine for millennia.

In our dynasty, Ye Tianshi, in treating diseases, uniquely distinguished among the Upper, Middle, and Lower Jiao (Triple Burner) beyond just Exterior and Interior. This truly elucidated theories not previously expounded by predecessors. The Lung belongs to the Upper Jiao, the Heart and Spleen to the Middle Jiao, and the Kidney to the Lower Jiao. The human Jiao runs from top to bottom, like latitude in the sky; the human Jiao runs from bottom to top, like longitude in the sky. One vertical, one horizontal, they use each other mutually and cannot be neglected. Moreover, when Wind-Cold invades the body, it mostly enters through the pores.

The human body consists merely of Yin and Yang. What Yin and Yang differentiate are merely Ying (Nutritive Qi) and Wei (Defensive Qi). What Ying and Wei govern are merely Blood and Qi. Blood belongs to Yin, Qi belongs to Yang; Blood belongs to Ying, Qi belongs to Wei. This is common knowledge. Thus, people believe Qi should ascend and not descend, while Blood should descend and not ascend. However, if Qi sinks, it leads to diarrhea or collapse; if Qi rushes upward, it leads to asthma or hiccups; if Blood surges upward, it leads to hematemesis or epistaxis; if Blood leaks downward, it leads metrorrhagia or uterine bleeding. These are all pathological states. Therefore, using Ginseng and Astragalus to tonify Qi takes advantage of their ascending properties, but must be assisted by Yin-tonifying herbs, so that within ascent there is descent. Using Angelica Sinensis and Rehmannia to tonify Yin takes advantage of their moistening and descending properties, but must be assisted by Yang-tonifying herbs, so that within descent there is ascent.

Generally speaking, sweet herbs harmonize the Middle Jiao, bitter herbs dry dampness, sour herbs astringe, pungent herbs disperse, salty herbs soften hardness, and bland herbs promote diuresis. This is the Direct Treatment (Zheng Zhi). Treating cold with cold (using cold herbs for true heat presenting as false cold), treating heat with heat (using warm herbs for true cold presenting as false heat), treating obstruction with purgatives (using draining herbs for excess-type obstructive symptoms), and treating stagnation with tonics (using tonifying herbs for deficiency-type stagnant symptoms) constitute the Contrary Treatment (Cong Zhi). For deficiency, tonify the Mother organ; also, the Child can make the Mother full. For excess, drain the Child; also, the Child can steal the Mother's Qi. Because of the generating relationship, they mutually utilize each other; this is the Constant Method. For Spleen disease, soothe the Liver; for Liver disease, strengthen the Spleen; for Kidney disease, clear the Heart Fire; for Heart disease, nourish the Kidney Water. This is the Two-Step Treatment (Ge Er Zhi Fa). For Liver disease, benefit the Lung (such as Zuo Jin Tang); for Spleen/Stomach disease, warm the Kidney Yang, or assist the Ming Men (Gate of Life) Fire. This is the Three-Step Treatment (Ge San Zhi Fa).

The world groups Zhang Yuansu, Li Dongyuan, Liu Wansu, and Zhu Danxi together, yet lists Zhang Zhongjing among them. I pondered that Zhang Zhongjing was a person of the Eastern Han Dynasty, and his formulas and theories were entirely based on the *Su Wen* (Basic Questions) and *Ling Shu* (Spiritual Pivot). He is actually the ancestor of medical practitioners for a hundred generations; how could the other three merely follow him? Later, reading Lu Dingpu’s miscellaneous notes, it stated that Zhang Zhongjing is not in the list of the Four Masters; the "Zhang" refers to Zhang Zihe (Zhang Congzheng), who was on par with Dongyuan, Hejian, and Danxi. Their treatment methods each elucidated a specific principle, establishing distinct schools. This argument is very fair and aligns with my own views, so I hastily recorded it.

Qi-tonifying herbs are mostly warm and rarely cool; Blood-tonifying herbs are mostly cool and rarely warm. This is the differentiation of Yin and Yang. However, the Lung governs exhalation, and the Kidney governs inhalation. When Qi is deficient... [text missing], this is not the method to assist Righteous Qi. When Yang generates, Yin generates; when Qi is strong, it controls Blood. In cases of Blood deficiency, some are suitable for supporting Yang and tonifying Lung Qi, and warm herbs are appropriate. However, one must absolutely not use overly warm herbs like Realgar, Aconite, Sichuan Pepper, or Ginger for those with little Blood, as these are sufficient to consume the Blood.

Ginseng is the supreme herb for supporting Yuan Qi (Original Qi). It is suitable regardless of whether used for releasing the Exterior or purging the Interior. Therefore, ancient formulas used Ginseng extensively. However, the Ginseng used then came from Shangdang, located in the Central Plains, with a mild nature and flavor. Our dynasty uses Liaodong Ginseng, which is located偏 (biased) to the East, thus having a warm nature that ascends. As for Goryeo Ginseng from Korea and Japanese Ginseng, the further east the origin, the more biased its nature. Its efficacy in tonifying deficiency is insufficient, while its tendency to aid Heat is excessive. Those with external pathogens or chronic Liver disease must use it with discretion. One cannot rigidly apply ancient formulas to modern herbs. By extension, if Atractylodes Macrocephala is not wild, its nature is thin and dry; if Cinnamon Bark is not grown in kiln caves, its flavor is pungent and causes Heat to flare upward (Annam Cinnamon is no longer available). Neither is sufficient for success. Slight impropriety leads to many adverse effects, which doctors should know.

Among the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire), Wind is primary. Among heaven and earth, only Wind penetrates everywhere. Thus, in human illness, Wind syndromes are heaviest and can combine with the other five excesses, generating hundreds of diseases. Combinations include: Cold-Wind, Damp-Wind, Summerheat-Wind, Dryness-Wind, Fire-Wind. Essentially, various syndromes can generate Wind. Variations include Head Wind, Brain Wind, Throat Wind, Liver Wind, Stomach Wind, Intestinal Wind, Crisscross Knee Wind, Scrotal Wind, Joint Wind, as well as Wind Pathogen, Wind Bi (Arthralgia), Wind Paralysis, Wind Urticaria, Wind Hemiplegia, Wind Mania, etc. Light severity is Wind Injury; severe severity is Wind Stroke. Ultimately, it is because True Qi is first deficient, and Ying/Wei are sparse, allowing Wind Pathogens to invade via deficiency. Hence, Wind syndromes are mostly Deficiency and rarely Excess. The treatment methods of Dongyuan, Hejian, and Danxi vary in promoting Qi circulation, nourishing Blood, resolving Phlegm, and clearing Heat, without exclusively using Wind-dispelling agents.

Zhang Zhongjing wrote *Shang Han Lun* (Treatise on Cold Damage), likely using Cold Disease as the outline for various syndromes. In the human body, Yang abundance brings life, Yin abundance brings death. Cold is a Yin-miserable Qi; invading the body causes disease and depletes Yang. Therefore, Zhang Zhongjing’s formulas mostly prioritize warm agents. Except for purgative formulas: if Cold Pathogen is in the Exterior, use warm dispersants to induce sweating, such as Ephedra Decoction (Ma Huang Tang), Cinnamon Twig Decoction (Gui Zhi Tang), or Major Green Dragon Decoction (Da Qing Long Tang). If Cold Pathogen is in the Interior, use warm-hot agents to dispel it, such as Center Regulating Decoction (Li Zhong Tang) or Four Reversal Decoction (Si Ni Tang). This is truly the core method for treating Cold Diseases, which later generations should observe. Regarding seasonal pathogens, whether Warm, Damp, or Summerheat, some resemble Cold Damage, but treatments differ greatly. Do not exclusively use warm-hot herbs, lest you cause delay. Symptoms like Summerheat Strike or Dampness Strike are distinctly different from Wind Stroke. Adapting to circumstances is the physician's essential secret.

Summerheat is the Yang Pathogen of summer, entering via mouth and nose. The Spleen Meridian suffers first, followed by the Heart and Lungs. Heat syndromes are mostly Yang, belonging to Qi excess; Summerheat syndromes are mostly Yin, belonging to Qi deficiency. This differs greatly from treating Cold Pathogen invasion. It suits warm dispersal rather than overheating, and cooling rather than over-chilling. Zhang Zhongjing’s formulas are mostly unusable. Summerheat has many combined syndromes: combined with Wind, Cold, Dampness, or Food Stagnation. Most commonly, it combines with Dampness and Food Stagnation. In summer, the earth is humid and muggy; Summerheat inevitably carries Dampness. Without internal Food Stagnation, it will not become a major disaster. However, Malaria or Dysentery, or Cholera-like vomiting and diarrhea occurring at the time are mild. If it becomes Latent Summerheat after autumn, it is extremely difficult to cure, worsening in late autumn. If onset occurs after Frost Descent, according to the theory of Five Elements and Six Qi...

The Spleen belongs to Wet Earth. Dampness is the Qi of Earth. Rising from the ground, attaching to humans, it differs in Internal and External contraction. Rain and sweat soaking the body injure the Skin and Collaterals, potentially combining with Wind, Cold, Heat, or Summerheat. Severe Dampness Invasion can cause facial paralysis, stiff tongue, slurred speech, tendon spasm, and limb numbness, resembling Wind Stroke but must not be treated as such. Generally, Dampness in the Exterior requires sweating (releasing the muscle layer); Dampness in the Interior requires purging (unblocking urination and defecation). One must support the Spleen to solidify it and warm the Middle to dispel it. This completes the task of treating Dampness.

The Classics state: Dryness is transformed from the Metal Qi of Autumn (Yangming). Metal generates Water. Dryness fails to nourish Kidney Yin, cutting off the source. Once Kidney Water is exhausted, it cannot irrigate the Five Zang organs or nourish the bones, causing the whole body to wither and become drier. This disease often arises from excessive alcohol and sexual activity, with Fire abundant and Water deficient, gradually worsening. Some arise from Lung affected by Wind-Fire, chronic cough with phlegm, long-term fluid consumption leading to Dryness Syndromes. Symptoms include skin scaling, emaciation, dry throat, and hoarseness. Generally, treat with sweet-cold fluids that generate Water. Mild cases use Asparagus Root, Rehmannia, Pear Juice, Lotus Root Powder. Severe cases use Turtle and Softshell Turtle Gel, Cow/Sheep Milk, Bird's Nest. Especially advisable to calm the Heart and reduce desires, rinse mouth and swallow saliva, naturally recovering. If warm agents are used again, or alcohol/sex not abstained from, death will result. Do not ignore this.

The Five Zang and Six Fu organs each possess True Qi. Excess Qi becomes Fire. Thus, all meridians have Fire, primarily governed by the Heart, Liver, and Ming Men (Gate of Life). Labor injury, depression, extreme anger, and extreme joy all generate Fire. Liver Fire excess injures the Spleen; Heart Fire flares injures the Lung; Ming Men Fire blazing injures the Kidney. This Fire is internally generated. Regarding internal Cold, Summerheat, and Dampness, if the body develops high fever, long stagnation turns into Fire. This is transmission of seasonal pathogens. Furthermore, Liver transfers Heat to Gallbladder, Heart to Small Intestine, Lung to Large Intestine, Kidney to Bladder. The disasters are endless. Since Fire is a disaster, it must be drained. Draining via dispersal includes Bupleurum and Kudzu. Draining via purging includes Scutellaria and Coptis. Draining via nourishing Yin includes Anemarrhena, Phellodendron, and Ophiopogon. Draining via tonifying Qi includes Ginseng, [Missing Character], and Licorice (the so-called "Sweet-Warm conquers Great Heat"). This depends on the skillful user to adapt and connect.

Whenever contracting Seasonal Epidemics, initially one feels chills or cold limbs. Thus, laypeople call any external contraction Wind-Warmth, Summerheat, or Dampness "Cold Damage" and treat with dispersal. After days, pathogen enters Middle Jiao or moves from Exterior to Interior, turning to Heat, causing thirst, constipation, irritability, and delirium. Laypeople call this "Fire Syndrome" and treat with cooling purgatives. They do not know that the Three Causes received lead to varied changes. One must treat according to syndromes and meridians to be effective. Otherwise, even if most of a formula is correct, if one or two herbs are unsuitable, not only will the drugs fail, but adverse effects will appear immediately. Successors, unaware of what was wrong, change methods. This causes much harm.

Treatment methods rely equally on Observation, Listening/Smelling, Inquiry, and Palpation. Modern physicians focus solely on pulse diagnosis, leading to omissions. Patients have different constitutions, resulting in varied pulses (slow/fast, large/small). If the physician is unfamiliar and patient reports are mixed, or severity/virtue shift, relying solely on pulse to prescribe is inappropriate. Initial palpation must be cautious. One must judge circumstances and principles, have firm insights, then prescribe, preventing complications in the initial formula. Like a skilled chess player calculating dozens of moves ahead. If one waits for mismatched medication to plan anew, even if curative, it is not good medicine, due to prolonged illness. Moreover, if complications arise rapidly, changing course is hard. Fear of patients switching to quacks leads to delays. Human life is precious; how can one err twice?

Health preservers should harmonize Qi and Blood daily, conserve Spirit. Indulge not in alcohol, sex, or desires. Do not overexert emotions (anger, joy, sorrow, fear). Then naturally... [text missing]. This is indeed not merit attributable to the physician.

Youths careless with alcohol and sex, suddenly contracting seasonal pathogens, suffer dizziness, heaviness, and exhaustion. This is due to early damage to Righteous Qi. The Classics state: [Text Missing]... Drainage leads to Yin loss. Prolonged, it causes confusion, shortness of breath, convulsions, and syncope. Physicians, seeing previous use of dispersing/purgative drugs, administer Ginseng, [Missing], Angelica, Rehmannia, possibly adding Cinnamon and Aconite. Such cases have no hope of survival, deeply lamentable. Treatment should use Ginseng and Perilla Drink or Immature Bitter Orange and Atractylodes Pill before pathogen enters Interior. If after 8-9 days symptoms persist and worsen, use Pulse Restoring Decoction (Modified Zhi Gan Cao Tang) to boost Righteous Qi and nourish True Yin, then pathogen resolves. If medication error leads to critical danger, use Cal Bovis Pills, Treasure of the Ultimate Elixir, or Purple Snow Pills酌情 (discretionarily). Can save 20-30%. These are my experiences.

During Jiaqing and Daoguang reigns, a famous doctor in Yue region was overly cautious. Knowing the syndrome required purging/dredging, he refused sudden tonification. Days passed before slight tonification, by which time the patient was exhausted. I questioned him. He said: Ancients' formulas for Exterior release (Green Dragons), Interior purging (Chengqi, Xianxiong), and Harmonizing (Chaihu) imply caution: light first, heavy later. If light works, heavy is unnecessary. I smiled silently. Zhang Zhongjing’s formulas have specific indications. Heavy or light, no compromise. How could one test light first, then heavy?

Saying: "All diseases arise from Phlegm." Phlegm is not in *Nei Jing*. Zhang Zhongjing mentions Five Drinks, including Phlegm-Drink. Later physicians discuss Phlegm treatment frequently, prioritizing Spleen. Phlegm transforms from food. Strong Spleen transport prevents Phlegm; weak Spleen allows Phlegm to rise to Lung orifices. Thus, Phlegm formulas are mostly Spleen/Lung herbs. Phlegm arises from Cold, Fire, Wind, or Dampness. Each has a root; these are Excess Phlegm. Deficient Phlegm has two types: Spleen deficiency failing to transform food, Fire stagnation creating thick/turbid Phlegm; Kidney deficiency failing to control Water, Water flooding creating thin/clear Phlegm. Treat by distinguishing Yin/Yang, tonifying Qi or Yin, not solely focusing on eliminating Phlegm. Modern people smoke tobacco, eat rich foods. Morning phlegm-cough is severe. Even with medication, hard to eliminate. Deep accumulation, rattling phlegm from Dantian to chest, is critical.

Zuo Zhuan says: Not ghosts, not food. Ghosts are one aspect of disease. Barbarian Hui tribes believe in witchcraft/ghosts, praying when sick. Yue women favor this. ... [Text Missing] ... Prayer cures instantly. But if Original Qi is weak, it is "Ghost-caused Illness." If sick for days, Spirit weak, ghosts demand food, prayer removes ghosts but illness remains, requiring medical treatment. This is "Illness-caused Ghosts."总之 (In short), encountering Ghost Disease, one should dispel it. Do not rely on Confucian denial of ghosts to hinder treatment, burdening the patient. Prioritize medicine, do not blindly obey ghosts. As for karmic retribution from past lives, meeting fate demands death; Buddhist sutras and immortal scriptures cannot save them.

Obese people have much Phlegm; use Six Gentlemen Decoction. Emaciated people have much Fire; use Qiongyu Paste. Children have much Yin Deficiency; use Six Flavor Rehmannia Decoction. Elderly have much Yang Deficiency; use Seven Treasures Beard Beautifying Pill. These are daily regulation methods. Treatment involves Acupuncture/Moxibustion and Herbs equally, as per *Zuo Zhuan* "Attack and Reach." Modern acupuncture lost true transmission. Moxibustion based on Bronze Man diagrams still works for early consumptive diseases and Wind-Damp Bi syndromes. Taiyi Thunder Fire Divine Needle has few formulas, none fully effective. In recent 20 years, Sha (Sand/Plague) treatment is prevalent. All ages/genders, winter/summer, with heart/abdominal pain, Liver/Stomach Qi pain, or cold/fever/vomiting/diarrhea, are called Sha. Prick tongue underside and arm collaterals to bleed, called "Releasing Sha." Sometimes cures, hailed as divine skill, spreading widely. During temperature fluctuations, few avoid pricking. Sha is not in *Nei Jing*, nor mentioned by masters. Only Yin-Yang Water for Dry Cholera (Intestinal Colic Sha) appears later. Materia Medica/Formulary books mention no bloodletting. Generally, pathogen enters Blood level, stagnates, blood turns black upon pricking. If color unchanged, not Sha. Pricking non-Sha harms Qi/Blood, empties collaterals, invites pathogens. Sha-prickers often get Stomach issues; repeated pricking leads to weakness and death. Needles/blades are ancient methods, now lost. Unless extreme suffocation/pain, life hanging by thread, use medication. Do not lightly try blades. I advised earnestly, ignored. Is it fate? Or replacing war casualties? Alas, tragic!

Recently, Opium spreads globally. Half by idle youths seeking pleasure; half by clerks working late nights; some use it for illness. Opium is Poppy sap, astringent intestines/lungs. Foreigners mix poison, boil into paste. Effective for chronic diarrhea/cough with slipping, or Liver disease not affecting Upper Jiao. But addiction forms before cure, like bringing wolves to drive tigers. Ineffective users add smoking hazard. Even if cured, reliant on opium. Long-term Qi/Blood depletion, cough/diarrhea/Liver disease worsens upon cessation. Opium fails, other drugs fail, becoming fatal. *Ben Cao Gang Mu* and *Zheng Zhi Zhun Sheng* have countless good drugs/formulas. Why use this poison?