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Heart governs fright. In excess, there is crying and shouting, fever, desire for water, and convulsions; in deficiency, there is palpitations and restlessness while lying down.
The Heart governs fright. In an Excess pattern, symptoms include crying and shouting, fever, a desire to drink water, and convulsions (Chou). In a Deficiency pattern, symptoms include palpitations and mental restlessness when lying down.

Liver governs wind. In excess, there is staring eyes, loud crying, yawning, neck stiffness, and sudden chest oppression; in deficiency, there is grinding of teeth and frequent yawning. If Qi is hot, the pathogen arises externally; if Qi is cold, it arises internally (Bencao Gangmu adds the character "wind" after both "arises externally" and "arises internally").
The Liver governs Wind. In an Excess pattern, symptoms include fixed gaze, loud crying, frequent yawning, neck stiffness, and sudden chest oppression. In a Deficiency pattern, symptoms include bruxism (grinding of teeth) and frequent yawning. If the internal Qi is hot, the pathology manifests externally; if the internal Qi is cold, it manifests internally. (Note: Bencao Gangmu inserts the character "Wind" after both "manifests externally" and "manifests internally".)

Spleen governs lethargy. In excess, there is drowsiness, body heat, and desire for water; in deficiency, there is vomiting, diarrhea, and generation of wind.
The Spleen governs lethargy. In an Excess pattern, symptoms include drowsiness, feverish sensation, and desire for water. In a Deficiency pattern, symptoms include vomiting, diarrhea, and the generation of Internal Wind.

Lung governs panting. In excess, there is chest distress, confusion, and rapid breathing; some patients desire water, others do not; in deficiency, there is choking sensations and long sighs.
The Lung governs panting. In an Excess pattern, symptoms include chest distress, mental agitation, and rapid breathing; some patients have a desire for water, while others do not. In a Deficiency pattern, symptoms include a sensation of choking or obstruction and frequent long sighs.

Kidney governs deficiency and has no excess; only in cases of smallpox/varicella, if Kidney Qi is in excess, the lesions turn black and sink.
The Kidney primarily manifests as Deficiency and does not typically present with Excess patterns. The exception is in cases of eruptive diseases like smallpox or chickenpox; if the Kidney is in excess, the lesions will turn black and become depressed.

One must further distinguish between Excess and Deficiency patterns. For example, if a Lung disease presents with Liver signs such as bruxism and frequent yawning, it is easy to treat because the Liver Qi is deficient and cannot overcome the Lung. If there are signs of fixed gaze, loud crying, neck stiffness, and sudden chest oppression, it is difficult to treat because prolonged Lung disease leads to Lung Qi deficiency and cold, while strong Liver Excess overcomes the Lung. Based on the newness/chronicity and Excess/Deficiency of the disease, tonify the Mother in Deficiency and drain the Child in Excess.
It is essential to further differentiate between Excess and Deficiency patterns. For instance, if a Lung disorder presents with Liver signs such as bruxism and frequent yawning, it is easily treated because the Liver Qi is deficient and fails to control the Lung. Conversely, if symptoms include fixed gaze, loud crying, neck stiffness, and sudden chest oppression, it is difficult to treat because chronic Lung disease leads to Lung Qi deficiency and cold, whereas strong Liver Excess counter-controls the Lung. According to whether the disease is recent or chronic, and Excess or Deficient, one should tonify the Mother organ in Deficiency patterns and drain the Child organ in Excess patterns.

Liver disease: crying and shouting, fixed gaze, yawning, sudden chest oppression, neck stiffness.
Liver Disease: Crying and shouting, fixed gaze, yawning, sudden chest oppression, and neck stiffness.

Heart disease: frequent crying and shouting, fright, palpitations, shaking of hands and feet, fever, desire for water.
Heart Disease: Frequent crying and shouting, fright, palpitations, tremors of the extremities, fever, and desire for water.

Spleen disease: lethargy, diarrhea, loss of appetite.
Spleen Disease: Lethargy, diarrhea, and anorexia.

Lung disease: chest distress and agitation, choking sensation, long sighs, shortness of breath, and rapid panting.
Lung Disease: Chest distress and agitation, a sensation of choking, long sighs, shortness of breath, and rapid panting.

Kidney disease: lackluster eyes, photophobia, heavy body and bones.
Kidney Disease: Lackluster eyes (absence of Jing/Guang), photophobia, and a sensation of heaviness in the body and bones.

[Li Dongyuan] Heat originates from the Heart, Cold from the Kidney, cough with rebellious Qi from the Lung, Wind from the Liver, and diarrhea from the Spleen. If diarrhea is accompanied by cough and rebellious Qi, it is a Spleen-Lung disease; one should combine Xie Bai San and Yi Huang San. The Spleen dislikes dampness, and the Lung dislikes dryness and rebellious Qi. If diarrhea presents with yellow complexion and audible borborygmi, Li Zhong Tang is indicated. If diarrhea is accompanied by vomiting, Fu Ling Ban Xia Tang is indicated. If diarrhea is accompanied by thirst and significant heat, Huang Qin Hou Po Tang is indicated. If there is no thirst and mild heat, Bai Zhu Hou Po Tang is indicated. Other Zang organs with combined symptoms can be deduced similarly. See the following discussion for detailed medication adjustments according to the four seasons.
[Li Dongyuan]: Heat syndromes originate from the Heart; Cold syndromes from the Kidney; cough with rebellious Qi from the Lung; Wind from the Liver; and diarrhea from the Spleen. If diarrhea is accompanied by cough and rebellious Qi, it indicates a Spleen and Lung disorder; one should administer a combination of Xie Bai San and Yi Huang San, as the Spleen dislikes Dampness and the Lung dislikes Dryness and Rebellious Qi. If diarrhea presents with a sallow complexion and audible borborygmi, Li Zhong Tang is indicated. If diarrhea is accompanied by vomiting, Fu Ling Ban Xia Tang is indicated. If diarrhea is accompanied by thirst and marked heat, Huang Qin Hou Po Tang is indicated. If there is no thirst and mild heat, Bai Zhu Hou Po Tang is indicated. Combined symptoms in other Zang organs can be inferred by analogy. Refer to the subsequent discussion for detailed herbal modifications based on the seasonal changes.

If Liver disease appears in Autumn (or late afternoon), it indicates Liver overcoming Lung. Since Lung Qi is weak and cannot overcome Liver, one should tonify the Spleen to treat the Liver. Tonifying the Spleen makes the Child solid (Mother generates Child); use Yi Huang San to tonify the Spleen and Xie Qing Wan to treat the Liver. If Lung disease appears in Spring (or early morning), it indicates Lung overcoming Liver. Since Liver Qi is weak, it becomes diseased; one should tonify the Liver and Kidney to treat the Lung. Use Di Huang Wan to tonify the Liver and Kidney and Xie Bai San to treat the Lung. If Liver disease appears in Autumn, Wood is prosperous, and Liver overcomes Lung; one should tonify the Lung and drain the Liver. Mild cases resolve; severe cases result in white lips and death. If Lung disease appears in Spring, Metal is prosperous, and Lung overcomes Liver; one should drain the Lung. Mild cases resolve; severe cases result in pale blue eyes, inevitable fright, and possibly red eyes with convulsions (Zhang Yuansu states: pale blue eyes indicate Liver weakness). If Heart disease appears in Winter, Fire is prosperous, and Heart overcomes Kidney; one should tonify the Kidney and treat the Heart. Mild cases resolve; severe cases result in downward convulsions and muteness due to Kidney weakness. If Kidney disease appears in Summer, Water overcomes Fire, and Kidney overcomes Heart; one should drain the Kidney. Mild cases resolve; severe cases result in palpitations and convulsions. Spleen disease appearing in other seasons follows this logic. Smooth patterns are easy to treat; reversed patterns are difficult. Spleen weakness presents with red and yellow face/eyes. Treat Five Zang counter-control patterns according to symptoms.
If Liver pathology manifests in Autumn (or during the You hour/late afternoon), it signifies Liver overacting on Lung. Because Lung Qi is deficient and unable to control Liver, treatment should focus on tonifying the Spleen to manage the Liver. By tonifying the Spleen (the Mother), the Child (Liver) becomes robust; utilize Yi Huang San to tonify the Spleen and Xie Qing Wan to drain the Liver. If Lung pathology manifests in Spring (or during the Mao hour/early morning), it signifies Lung overacting on Liver. Because Liver Qi is deficient, it succumbs to disease; treatment should focus on tonifying the Liver and Kidney to support the Lung. Utilize Liu Wei Di Huang Wan to tonify the Liver and Kidney and Xie Bai San to drain the Lung. If Liver pathology appears in Autumn, Wood Qi is vigorous, leading to Liver overacting on Lung; one should tonify the Lung and drain the Liver. In mild cases, the Liver condition resolves; in severe cases, the lips turn white, indicating death. If Lung pathology appears in Spring, Metal Qi is vigorous, leading to Lung overacting on Liver; one should drain the Lung. In mild cases, the Lung condition resolves; in severe cases, the eyes appear pale cyan, inevitably leading to fright, and if red, convulsions may occur (Zhang Yuansu notes: pale cyan eyes indicate Liver deficiency). If Heart pathology appears in Winter, Fire Qi is vigorous, leading to Heart overacting on Kidney; one should tonify the Kidney and treat the Heart. In mild cases, the Heart condition resolves; in severe cases, downward convulsions and muteness occur due to Kidney deficiency. If Kidney pathology appears in Summer, Water overacts on Fire, and Kidney overacts on Heart; one should drain the Kidney. In mild cases, the Kidney condition resolves; in severe cases, palpitations and convulsions occur. Spleen pathology appearing in other seasons follows this principle. Patterns that follow the seasonal cycle are easy to treat; those that oppose it are difficult. Spleen deficiency presents with a red and yellow complexion. Treat Five Zang counter-control patterns according to the specific manifestations.

[Luo Pi] The above discusses Five Zang counter-control, where disease follows seasonal timing. This expands upon the principles of the *Neijing* chapter "Organ Qi Methods According to Time," truly revealing insights previously unexplored. For example, if Liver disease appears in Spring or morning, it is the Liver diseased in its own position. If it instead appears in Autumn or late afternoon (positions of Lung), it indicates extreme Lung deficiency allowing Liver to overact; thus, one should tonify Spleen and Lung and drain Liver. The rest follows this logic. [Li Dongyuan] When Liver overacts on Lung, Liver disease presents with body heat and convulsions, accompanied by Lung deficiency signs like panting and shortness of breath. If the disease manifests during Shen, You, and Xu hours, it indicates true Liver strength. The *Neijing* states: "Being controlled but unable to control is called True Strength." The method is to tonify Spleen and Lung and drain Liver, using Dao Chi San and Xie Huang San.
[Luo Pi]: The preceding text discusses the counter-control among the Five Zang organs, where pathological manifestations align with seasonal timings. This elaborates on the principles found in the *Huangdi Neijing* section "Fa Shi Lun" (Discussion on Organ Qi Laws Relative to Time), genuinely elucidating insights not previously expounded. For instance, if Liver pathology manifests in Spring or during the morning hours, it represents the Liver being diseased in its primary domain. However, if it manifests in Autumn or during the late afternoon hours (times associated with the Lung), it indicates extreme Lung deficiency permitting Liver Qi to overact; therefore, treatment should involve tonifying the Spleen and Lung while draining the Liver. Similar logic applies to other scenarios. [Li Dongyuan]: When Liver overacts on Lung, Liver pathology presents with fever and convulsions, accompanied by signs of Lung deficiency such as wheezing and shortness of breath. If these symptoms manifest during the Shen, You, and Xu hours, it signifies "True Strength" of the Liver. As stated in the *Neijing*: "To be constrained yet unable to constrain is termed True Strength." The therapeutic approach is to tonify the Spleen and Lung and drain the Liver, utilizing Dao Chi San and Xie Huang San.

Liu Zongnong said: These all concern Five Zang counter-control, where the disease mechanism adheres to the principles of Five Element generation, restriction, and transformation. Infants are fragile, their blood and Qi undetermined, and their Zang-Fu spirit incomplete, lacking seven emotions and six desires. Thus, they suffer from diseases of Zang Qi excess, deficiency, over-acting, and riding. Yet, common people fail to understand this, often misdiagnosing them as external contraction or internal injury, leading to many wrongful deaths. Alas! Qian's theories had omissions, fortunately supplemented by Jiegu. Now, with these additions, it is a boundless benefit.
Liu Zongnong remarked: All these conditions pertain to the counter-control among the Five Zang organs, where the disease mechanism strictly adheres to the principles of the Five Elements' generation, restriction, and transformation. Since infants are physically fragile, with unsettled Qi and Blood, and immature Zang-Fu functions and Spirit, devoid of the Seven Emotions and Six Desires, they are prone to disorders arising from the excess, deficiency, over-acting, and riding of Zang Qi. However, laypersons often fail to comprehend this principle, frequently misattributing such conditions to external contractions or internal injuries, resulting in numerous preventable deaths. How tragic! Although Qian Yizhi's discussions contained some omissions, they were fortunately supplemented by Zhang Jiegu (Li Dongyuan). The inclusion of these annotations here constitutes a profound and enduring benefit.