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Furthermore, in warm-heat diseases (Wenre Bing), after examining the tongue, one must also inspect the teeth. Teeth are the surplus of bone (Chi wei gu zhi yu), and the gums are the collaterals of the Stomach meridian (Yin wei wei zhi luo). If pathogenic heat does not dry up Stomach fluids (Wei Jin), it will inevitably consume Kidney Yin (Shen Ye). Moreover, the blood of these two meridians flows through this area. When the disease is deep and moves blood, clots form on the teeth. Yang-type bleeding appears purple, like dried lacquer; Yin-type bleeding appears yellowish-brown, like soybean paste. If Yang-type bleeding is seen, treatment focuses on stabilizing the Stomach; if Yin-type bleeding is seen, saving the Kidney is essential. However, a color resembling soybean paste indicates a dangerous prognosis. If the symptoms are not yet adverse, it may still be treatable; otherwise, it is difficult to treat. Why? Because Yin fluids are exhausted, and Yang Qi rebels upward (Yang Shang Jue).

If the teeth are shiny and dry like stone, it indicates severe Heat in the Wei (Defensive) level (Wei Re Shen). If there is no sweat and aversion to cold, it indicates an excess of Wei Qi; the key treatment is to use pungent-cool herbs to clear Stomach Heat and induce sweating. If the teeth look like dead bones, it indicates exhaustion of Kidney fluids, which is difficult to treat. If the upper half is moist but the lower half is dry, it indicates that Water fails to ascend due to blazing Heart Fire (Xin Huo Yan Shang); urgently use cooling fluids to nourish Yin until the dryness turns moist. If teeth grinding or clenching occurs, it indicates wind-spasm transformed from damp-heat. Simple clenching is caused by Stomach Heat moving into its collaterals. If clenching occurs with weak pulse and symptoms, it is due to Stomach deficiency lacking grain essence to nourish Ying (Nutritive) Qi; this also causes clenching. Why? Deficiency often manifests as false excess. If the root of the tongue is stiff without shortening, and the jaw is locked tight, it is either phlegm-wind blocking collaterals or impending spasm; wiping with sour substances can open the jaw. Sour enters the sinews, and Wood energy drains Earth (Spleen/Stomach).

If dental plaque resembles gray cake, it indicates powerless Stomach Qi, loss of fluids, and heavy damp-turbidity, usually leading to death. If clear blood flows from tooth gaps with pain at the onset of illness, it is Stomach Fire rushing outward; without pain, it is Dragon Fire (Ministerial Fire) burning internally. Blackened teeth without plaque indicate death; blackened teeth with plaque indicate Kidney Heat and Stomach Yin depletion, requiring mild purgation or Yung Nu Jian (Jade Maiden Decoction) to clear Stomach Heat. Li Dongyuan treated long-term illness with unknown hunger/fullness and non-withered skin/hair as disorders of Phlegm-Fluids.

In Ye Tianshi’s cases for Wind Stroke, Ginseng is used only after the pathogenic force has receded, to cultivate Yuan Qi and nourish Zheng Qi. During severe illness, it is combined with wind-dispelling herbs in small doses (a few fen to one qian). My approach to using Ginseng can be inferred similarly. For Liver Wind with excessive Fire, Mr. Ye uses Antelope Horn (Lingyang Jiao), Gardenia (Shan Zhi), Forsythia (Lian Qiao), Trichosanthes Root (Hua Fen), Scrophularia (Yuan Shen), Fresh Rehmannia (Xian Sheng Di), Moutan Bark (Dan Pi), and Mulberry Leaf (Sang Ye) to clear Heat from the Upper Jiao orifices and collaterals, treating primarily from the Gallbladder. For excessive Phlegm, regulate the Yangming (Stomach), eliminating phlegm with Bamboo Sap (Zhu Li), Ginger Juice (Jiang Zhi), Acorus (Chang Pu), Tangerine Peel (Ju Hong), and Er Chen Tang. For Middle Jiao deficiency, use Ginseng, as in Waitai Fuling Yin. For Lower Jiao deficiency, treat from the Liver: tonify Kidney and nourish Liver, nurture Yin and subdue Yang, using sedative methods. For chronic cough, use Jianzhong Tang methods to treat Middle Jiao deficiency, following the principle of "tonifying the mother," a true orthodox method passed down from ancient sages. For cough due to Yin Fire and consumptive disease, this opposes Jianzhong Tang; the master used it effectively but misapplied it to consumptive disease due to imprecise differentiation.

Where there is Upper Excess, there is invariably Lower Deficiency. Light flavors clear the Upper Jiao to stabilize the Lower Jiao and facilitate storage. Regarding Hematemesis (Tu Xue): For hemoptysis with a firm Right pulse, it is caused by Liver-Kidney Yin injury; use Rehmannia (Di Huang), Donkey-hide Gelatin (E Jiao), Goji Berry (Gou Qi), and Schisandra (Wu Wei Zi). For wiry pulse with hypochondriac pain, use Perilla Seed (Su Zi), Peach Kernel (Tao Ren), Aquilaria Wood (Xiang), and Curcuma Tuber (Yu Jin). For massive bleeding filling basins, use Ge Kejiu's Huarui Shi San or Zhang Zhongjing's Da Huang Huang Lian Xie Xin Tang. Such detailed analysis provides a basis for diagnosis.

All diseases involve lingering pathogens that must be expelled to prevent chronicity. Only when Qi and Blood are about to collapse is emergency rescue required, excluding this rule; once stabilized, address the root cause. All types of aphonia have curable principles. Using Ophiopogon (Mai Dong), Schisandra (Wu Wei), Prepared Rehmannia (Shu Di), and Platycodon (Jie Geng) to tonify Lung Phlegm-Fire causing aphonia leads to death in almost all cases. Yet, Mai Dong and Wu Wei are considered spiritual elixirs for aphonia.

Generally, internal damage to Essence, Blood, Form, and Qi requires rich tonification if Stomach function is strong. If appetite is poor and post-heaven Qi is weak, rich tonics are hard to absorb; use Sheng Mai San combined with Si Jun Zi Tang to care for Spleen and Kidney. Clear pathogens in the Upper Jiao with light, clearing, Qi-moving herbs. Bitter-cold herbs for Middle/Lower Jiao worsen Upper Jiao obstruction. Dampness requires Yang to transform; extreme Yang extension leads to heavy damp transformation. In chronic deficiency weakness absorbing Warm Pathogens, with epigastric fullness and thirst, where Qi mechanism is blocked, do not use standard opening/dispersing herbs (like Xing Ren, Jie Geng, Dou Kou Ren, Niu Bang Zi). Instead, use light, ascending, bland harmonizers to move Upper Jiao Qi before proceeding to Stomach-nourishing methods.

Six Qi pathogens transform according to constitution. Yin deficiency leads to Fire dominance, with pathogens entering Ying/Blood levels. Yang deficiency leads to Dampness dominance, with pathogens affecting Qi levels. One tolerates clearing, the other warming; the nature of cloying herbs reflects this Yin-Yang distinction. Thin people risk Yin depletion; fat people risk Yang deficiency. Ancients investigated sleep and diet to diagnose. Current inability to sleep despite normal intake and unclear consciousness indicates Yuan Qi damage. Heat diseases consume True Yin; propose San Cai Tang intent.

Pain attacking Wei Qi from the back involves the Du Meridian, treated in Shaoyin. From the abdomen, it involves Chong/Ren meridians, treated in Jueyin, or by tonifying Yangming. This is the general principle.

Pathogens from coagulated fluids require pungent-unblocking aromatics. Pathogens from exhausted Essence/Blood require flesh-and-blood tonics. Pathogens in Yang can be dispersed; pathogens in Yin require warming meridians to push them out. Lingering pathogens are resolved differently based on method.

Upper Excess and Lower Deficiency: Treating Kidney deficiency with Cornus (Yu) and Rehmannia (Di) is not wrong. But Kidney Water contains True Fire (needs warming), while Liver Wood contains Ministerial Fire (needs cooling). Tonifying Kidney with warmth must be assisted by cooling Liver with salt-prepared herbs to avoid bias (e.g., Cistanche, Morinda, Goji with White Peony). Regarding Edema (Zhong Zhang): The Classic says, treat the upper if pathology descends. If descending and worsening below, treat upper first then lower.

The Neijing states three methods for Liver disease: Pungent to disperse/regulate, Sour to drain/consolidate, Sweet to relax/nourish. Use pungent-sweet-moist-warm tonics. Liver is a rigid organ, requiring softening for efficacy.

Consumptive pulse is always rapid, varying in floating-large-small. Floating-large-rapid indicates severe Yin deficiency. Small-rapid indicates extinction of Yang within Yin. Another type of Yang deficiency shows slow, large, uncollected pulse with faint strength.

Earth is the root of Five Elements, distributed through seasons via the Central Palace (Spleen). Fire relies on Earth not to blaze; Water relies on Earth not to flood; Metal relies on Earth to generate; Wood relies on Earth not to wither. Thus, Spleen Spirit is the Yellow Matron, Heart Spirit is the Infant, Kidney Spirit is the Maiden. Alchemists raise Kan to fill Li, requiring the Yellow Matron to unite male and female, emphasizing Spleen-Stomach as post-heaven root, not just for tonification. Zhang Zhongjing used Chengqi Tang for Stomach excess causing Heart-Kidney non-interaction. Li Dongyuan used Guipi Tang for Spleen deficiency causing same, both illustrating the Yellow Matron concept. Heart-Lung are masters of the body and leaders of Six Meridians. Diseases center on Qi-Blood. If sufficient, even Six Meridian invasion is harmless; if insufficient, the Ruler worries, ministers suffer disgrace. Early stage, Qi-Blood intact, is like a fortified state with ample troops/grain; proper strategy disperses thieves. Negligence allows thieves to grow,正气 declines, making final battle futile. Thus, for complicated diseases, know methods of tonifying right/draining evil or nourishing Yin/reducing fever. Medication must be individualized. Delicate skin/Qi deficiency/phlegm excess: use warm-dry. Dark complexion/dry body/Blood deficiency/Fire excess: use cool-clear. Thick skin/firm muscle: exterior excess, use muscle-releasing. Strong Stomach/sound Spleen: interior excess, use purgative. History of sores/toxins: heavy fetal toxin, use detoxification. These are good methods for individualized treatment, applicable beyond smallpox.

Two Kidneys are roots of Qi-Blood. Kidney Fire is source of Qi; Kidney Water is sea of Blood. Sufficient Fire generates Earth/Metal; sufficient Water generates Wood/Fire. Humans possess a Taiji; balance means health. Kidney Yin deficiency leads to Liver/Heart disease; Kidney Yang deficiency leads to Spleen/Lung disease. Extreme Yang excess/Yin depletion or Yin excess/Yang decline are critical stages. One requires saving Yin to suppress Yang; the other supporting Yang to control Yin. Flat treatment: Yin tonification lowers Fire; Fire tonification generates Qi. Understanding this makes one a medical hero, applicable to all diseases, not just smallpox.

Elderly have little Qi/Blood, suitable for Yin-Yang dual tonification (e.g., Ba Wei Wan, You Gui Yin/Wan). Children have tender/youthful Yang. Originally Yin-less, relying on youthful Yang to generate Yin-Blood. Cold-cool herbs injure True Yang; if illness causes heat, cool-clear is appropriate, but this doesn't mean children are purely Yang and should always use cold-cold herbs.

Classics say mistaken sweating leads to Yang collapse, first losing离家之阴 (Yin leaving home), then Kan Yang; Yin deficiency leaves Yang unsupported. Mistaken purging leads to Yin collapse, first losing Stomach Yang, then Spleen Yin; Yang collapse prevents Yin survival (Four Damages cannot be treated directly). Excess mistreated with Guizhi/Mahuang can be saved by skilled doctors. Deficiency mistreated with Xiaokui/Huanglian is incurable even by bright physicians. Treat six deficiency symptoms carefully. Kong Yili said: Ginseng solidifies pathogens but is indispensable for Qi deficiency failing to transform; Rehmannia is cloying but essential for Yin deficiency failing to sweat. Clinging to "drain evil preserve right" and using purgatives ignores that weak Zheng Qi cannot distribute fluids, leading to sudden collapse in deficiency patients, and toxins hiding until fatal. Thus, Cheng Zhitian proposed draining evil/preserving right for excess-heat, and tonifying right/draining evil for deficiency. For Qi deficiency, double Ginseng in detoxification to boost Qi and push out evil (use Dangshen/Shashen for poor). For Blood deficiency, double Rehmannia to nourish Blood and induce sweat. In epidemics, Yin-Blood deficiency is common because heat pathogens injure Yin-Blood most. I treat Yin-deficient high heat with Yung Nu Jian or Yangrong Tangs. Yang-excess high heat with San Huang Jiedu or Xijiao Dihuang. Rare Yang deficiency uses Shenmai/Sijunzi; Guizhi/Fuzi are rarely used (discussing epidemics). Even if cold-cold herbs were overused, give one dose, stop when Yin subsides, resume Yin nourishment. Do not use excess formulas for deficiency, nor excess methods for deficiency. A slight error in excess/deficiency leads to disaster, killing patients. Thus, carefully distinguish excess and deficiency during consultation.