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This is the method of direct treatment (Zheng Zhi). As for false cold, it is a Yang syndrome manifesting as Yin, where extreme fire resembles water. Although the exterior is cold, the interior is hot; the pulse is rapid and forceful, or deep but striking forcefully upon palpation; or the body is cold and the patient dislikes clothing; or there is hot constipation; or irritability, thirst, and desire to drink; or foul-smelling intestinal discharge. These indicate that aversion to cold is not true cold, but clearly a heat syndrome. This is what is called "extreme heat counteracting with cold transformation," also known as "Yang excess repelling Yin." False heat is when a Yin syndrome manifests as Yang, where extreme water resembles fire. Although the exterior is hot, the interior is cold; the pulse is faint and weak, or rapid but empty, or floating and large without root, or wiry and hollow (Xuan Kou) and intermittent. Although the body feels blazingly hot, the spirit is calm; although speech is delirious, the voice is weak. There may be false mania with tossing about, which stops when restrained. There may be flea-bite-like false macules, light red and finely scattered. The patient may prefer cold water but drinks little. The tongue coating may be red on the surface, yet the patient does not remove blankets. Urine may be frequent, yet stool is not dry. These indicate that aversion to heat is not true heat, but clearly a cold syndrome. This is what is called "extreme cold counteracting with heat transformation," also known as "Yin excess repelling Yang." These are all false diseases. For false cold, clear the internal heat; once internal heat is cleared, floating Yin will retreat. For false heat, warm the true Yang; once the middle warms, deflected fire returns to its origin. This belongs to the method of following treatment (Cong Zhi).

Regarding the treatment of deficiency and excess: excess is treated by purging, deficiency by tonifying; this is an unchangeable principle. However, extreme deficiency may present with excessive symptoms, which is false excess. Extreme excess may present with emaciated symptoms, which is false deficiency. In short, deficiency refers to deficiency of righteous Qi (Zheng Qi). It manifests as a pale/dismal complexion and fatigued form, depleted spirit and timid Qi. There may be spontaneous sweating that does not stop, incontinence of urine and feces, nocturnal emission or seminal leakage, vomiting and obstruction, prolonged illness with excessive purgation, shortness of breath resembling asthma, overexertion, sudden exhaustion and loss of will, or external symptoms appearing excess-like but the pulse is weak and lacking spirit. All these are deficiency syndromes requiring tonification. Excess refers to excess of pathogenic factors (Xie Qi). Pathogens may block the meridians externally, or knot internally within the Zang-Fu organs; Qi may stagnate and fail to circulate, or blood may remain stagnant and coagulate. Only when both the pulse and the disease presentation are robust is it an excess syndrome requiring attack/purging. However, between deficiency and excess, confusion is most common, and one must distinguish truth from falsehood. As stated in *Tong Ping Xu Shi Lun*: "When pathogenic factors are abundant, it is excess; when righteous Qi is depleted, it is deficiency." This is the general principle of deficiency and excess. If a person has depleted righteous Qi while pathogenic factors are flourishing, should one protect the righteous Qi and tonify it, or first attack the pathogenic factors? If the judgment is not accurate, life and death depend on it; thus, caution is essential. Righteous Qi is the root; pathogenic factors are the branch. If righteous Qi is already deficient, even if pathogenic factors are strong, they must not be attacked. For fear that pathogens will not be expelled while righteous Qi collapses first, leading to changes during respiration that cannot be handled. Therefore, in treating deficiency with pathogenic factors, one must first protect righteous Qi. If righteous Qi exists, harm will not occur. Moreover, tonification contains the intent of purging; tonifying Yin clears heat, tonifying Yang disperses cold. There is no case in the world where righteous Qi recovers while pathogens remain, nor where righteous Qi is exhausted while life is preserved. If unavoidable, one must weigh urgency and employ temporary expedients. Varying the dosage, embedding attack within defense, is acceptable. This is the method for treating deficiency. If righteous Qi is undamaged and pathogens are difficult to eliminate, tonification is inappropriate. Tonifying would leave righteous Qi unsupported while pathogens flourish, effectively arming the enemy and feeding the thief. Thus, for excess syndromes, one should directly remove pathogens; once pathogens are gone, the body is safe. The method must be precise and focused to achieve rapid results; this is the method for treating excess. Ultimately, only those capable of withstanding attack are true excess syndromes; excess can be attacked, so why worry? Those unable to withstand attack are deficiency syndromes. Once Qi departs and does not return, one should be terrified. This is the root and branch of pathogens and righteous Qi, which must be known.

False deficiency syndromes are rare, while false excess syndromes are most common. False cold is not difficult to treat, but false heat is often mismanaged. Excess tends toward heat, deficiency tends toward cold. As Zhu Danxi said: "Excess Qi is Fire." Thus, excess can tolerate cold, but one must know that deficiency of Qi is cold; therefore, deficiency can tolerate heat. Physicians who do not understand truth, falsehood, root, and branch cause infinite harm.

The Yellow Emperor asked: What is reverse treatment (Fan Zhi)? Qibo replied: Heat used with cold administration, cold used with heat administration, obstruction treated with obstruction, diarrhea treated with purgation. One must subdue the main factor and address the cause first. Initially, the approach seems similar, but the outcome differs. One can break accumulations, dissipate hardness, harmonize Qi, and ensure cure.
(Heat used with cold administration: e.g., severe cold congealing internally requires heat treatment. But if cold repels heat preventing entry, administer heat medicine cold. After swallowing, the cold nature dissipates, and the heat nature activates. The condition is not violated, and great benefit is achieved. This is heat used with cold administration. Cold used with heat administration: e.g., severe heat in the center. Cold medicine fails to enter; heat medicine worsens the disease. Administer cold medicine hot. After entering the abdomen, the heat dissipates, and the cold nature acts. The condition harmonizes, and the disease reduces. This is cold used with heat administration. As *Wu Chang Zheng Da Lun* states: Treat heat with cold, administer warmly; treat cold with heat, administer coolly. This embodies the meaning of cold used with heat and heat used with cold. Obstruction treated with obstruction: e.g., lower Qi deficiency with middle Jiao Qi stagnation. To scatter fullness worsens lower deficiency; to tonify lower worsens middle fullness. Not knowing the root, attacking fullness first yields temporary relief but eventual worsening and further Qi depletion. Knowing that small doses nourish stagnation while large doses promote circulation, severely tonify the lower to open the middle, lower deficiency self-corrects, middle fullness self-resolves. This is obstruction treated with obstruction. E.g., severe internal heat retention or severe internal cold congealing causing lingering diarrhea. Cold stagnation is treated with cold purgatives warmed by heat; heat stagnation is treated with heat purgatives cooled by cold. This is diarrhea treated with purgation. These four treatments address the root of the disease and seek its cause. Having obtained the root, treating truth with truth and falsehood with falsehood starts similarly but ends differently. This is reverse treatment, allowing one to break accumulations, dissipate hardness, harmonize Qi, and ensure cure.)

The Yellow Emperor asked: Good. What is the method for harmonized Qi? Qibo replied: Reverse and follow, follow and reverse, guide Qi to harmony. This is the way.
(The method for harmonized Qi refers to originally harmonious Qi accidentally affected by externals. Qibo's treatment involves reversing or following. Some require primary reversal with secondary following; some require primary following with secondary reversal. All serve to vent pathogens and restore harmony. This is the method for treating externals affecting harmonious Qi.)

From *Su Wen: Zhi Zhen Yao Da Lun*. The Yellow Emperor asked: What is the sovereign-minister-assistant-messenger system in prescriptions? Qibo replied: The agent treating the disease is Sovereign (Jun); assisting the Sovereign is Minister (Chen); responding to the Minister is Messenger (Shi). This does not refer to the Upper, Middle, and Lower grades.
(The agent is the key herb for the syndrome, hence Sovereign. Sovereign herbs are few in number and heavy in dose. Ministers have variable numbers and lighter doses, serving as guides and conductors. This is the meaning of Jun-Chen-Zuo-Shi, not the Upper/Middle/Lower grades. Shi is pronounced with a departing tone.) The Yellow Emperor asked: What are the three grades? Qibo replied: To clarify the distinction between good and bad properties.
(Prior discussion covered prescription structure (Jun-Chen-Zuo-Shi). This discusses herb properties (good/bad), hence Upper/Middle/Lower distinctions. Shennong said: Upper herbs are Sovereign, nourishing life corresponding to Heaven. Middle herbs are Ministers, nourishing nature corresponding to Humanity. Lower herbs are Assistants/Messengers, treating disease corresponding to Earth. Thus, *Ben Cao Jing* divides them into three grades, representing the distinction of good and bad properties.)

From *Su Wen: Zhi Zhen Yao Da Lun*. The Yellow Emperor asked: How about diseases inside and outside? Qibo replied: From inside to outside, regulate the inside; from outside to inside, treat the outside.
(Inside-to-outside: Inside is root. Outside-to-inside: Outside is root. Treating the root ensures cure.) From inside to outside, flourishing externally: regulate inside first, then treat outside. From outside to inside, flourishing internally: treat outside first, then regulate inside.
(Though flourishing at the branch, treatment addresses the root separately. Treating the main disease means treating the severe aspect. Like law regarding two crimes committed simultaneously, sentencing the heavier one. This chapter reflects the Three Causes theory. As *Jin Gui Yao Lue* states: A thousand illnesses do not exceed three categories. 1. Pathogens entering meridians to Zang-Fu, internal cause. 2. Transmission through limbs/nine orifices/blood vessels, blocked, external skin invasion. 3. Sexual excess, metal/blades, insects/beasts. Wu Ze's *San Yin Fang* categorizes Internal, External, and Non-internal/External causes, based on Zhang Zhongjing's three categories, which in turn derive from this text. Chen, chang zhen qie, disease.) The Yellow Emperor asked: Good, how about diseases inside and outside? (Previous question answered with root/branch theory. Re-asking to clarify Yin-Yang treatment.) Minor cases are regulated; next, balanced. Severe cases are seized, via sweating or purging. Cold, heat, warmth, coolness: diminish according to affinity, following what is beneficial.
(Fang means method. Yin-Yang refers to Three Yin/Three Yang. Inside/Outside refers to Zang-Fu/Meridians. Each stays in its place. Minor regulation: mild cold harmonized with warmth; mild heat harmonized with coolness. Next balancing: severe cold balanced with heat; severe heat balanced with cold. Seizure: severe pathogens directly attacked. Exterior severe: sweat; interior severe: purge. Whether cold, heat, warm, or cool, seek same-affinity agents to diminish, following benefits. Bie, bi lie qie.)

From *Su Wen: Wu Chang Zheng Da Lun*. The Yellow Emperor asked: Are there regulations for taking toxic and non-toxic herbs? (Yue means measure/regulation. *Jin Fu Pian* says: Regulating a prescription is like tying a bag; if full and untied, it leaks. If a prescription is made without regulation, spirit and efficacy are lost.) Qibo replied: Diseases have new/old onset; prescriptions have large/small sizes; toxic/non-toxic; regular regulations apply.
(Severe disease requires large dose; mild disease requires small dose. Non-toxic allows more; toxic allows less. These are standard regulations.) Great toxicity treats disease, remove six-tenths. Common toxicity removes seven-tenths. Minor toxicity removes eight-tenths. Non-toxic removes nine-tenths.
(Herbs vary in toxicity levels. Disease removal varies by tenths. Treatment principle: if herbs don't reach the disease, it's useless; if they exceed, they injure righteous Qi and cause other issues. Thus, know regulations and pace progress/stopping. Wang Bing notes: Great toxicity is fierce, causing much injury. Minor toxicity is mild, causing little injury. Common toxicity is intermediate. Stop at the limit to await recovery. Even non-toxic herbs, if taken long-term in excess, cause Qi imbalance and organ weakness. Hence, stop after removing nine-tenths.) Use grains, meats, fruits, vegetables to complete nourishment. Do not exceed, lest you injure righteous Qi.
(If disease is removed by six/tseven/eight/nine parts, remaining pathogens should be cleared by food therapy, not toxic herbs. As *Zang Qi Fa Shi Lun* states: Toxic herbs attack pathogens; grains nourish; fruits assist; meats benefit; vegetables fill. Herbs are hard to regulate precisely; diet must be appropriate. Excess injures righteous Qi.) If not fully resolved, repeat the method.
(If still unresolved, repeat previous methods gradually. Better to be cautious. First consider annual Qi, do not violate Heavenly Harmony. Five Movements have order, Six Qi have sequence, Four Seasons have commands, Yin-Yang have rhythm—all are Annual Qi. Human Qi responds with growth/storage. This is Heavenly Harmony. Ignoring Annual Qi changes and arbitrarily calling cold/heat leads to inability to distinguish pathogen/righteous Qi balance, offending Annual Qi and violating Heavenly Harmony. This is the cause of premature death.) Do not exacerbate excess, do not deplete deficiency, lest you bring early death upon people.
(If pathogen is excess and you aid it, you exacerbate excess. If righteous Qi is deficient and you attack, you deepen deficiency. Not knowing deficiency/excess, blindly applying purge/tonic makes excess worse and deficiency worse. True Qi daily declines, pathogen daily increases, bringing early death—this is the physician's fault.) Do not invite pathogens, do not lose righteous Qi, lest you cut off people's long life.
(Exacerbating excess invites pathogens. Depleting deficiency loses righteous Qi. Repeating this deeply warns against violating Heavenly Harmony and cutting off life, showing Annual Qi must be respected.)

Ju Yin (Wind-Wood) governs the Heaven (Si-Hai years). Wind excess prevailing: Balance with pungent-cool. (Wang Bing note: Ju Yin Qi is not yet intense heat, so use cool herbs to balance.) Assist with sweet-bitter. Use sweet to relax, sour to drain.
(Wind is Wood Qi; Metal overcomes it, so balance with pungent-cool. Too much pungent harms Qi, so assist with bitter-sweet. Bitter overcomes pungent; Sweet tonifies Qi. Wood nature is urgent, so sweet relaxes. Sour drains because sour is Wood's true flavor, and draining uses sour.) Clearness counteracts and prevails: Treat with sour-warm. Assist with sweet-bitter.
(If Qi is insufficient, Metal's clearness counteracts and prevails. Treat with sour-warm...)

Shao Yin (Fire-Sovereign) governs the Heaven (Zi-Wu years). Heat excess prevailing: Balance with salty-cold. Assist with sweet-bitter. Use sour to gather.
(Heat is Fire Qi; Water overcomes it, so balance with salty-cold. Assist with sweet-bitter. Sweet overcomes salty to prevent excess. Bitter drains to remove heat excess. Heat flourishing in meridians without gathering: use sour to gather.) Cold counteracts and prevails: Treat with sweet-warm. Assist with bitter-sour-pungent.
(If Qi is insufficient, Water's cold counteracts and prevails. Treat with sweet-warm. Sweet overcomes Water; Warm controls Cold. Assist with bitter-sour-pungent: Cold gets warmth from bitter, disperses from pungent. Fire overcome by Water means Heart suffers relaxation, so eat sour to gather.)

Tai Yin (Damp-Earth) governs the Heaven (Chou-Wei years). Damp excess prevailing: Balance with bitter-hot. Assist with sour-pungent. Use bitter to dry, pale to drain.
(Damp is Earth Qi; Dryness removes it, so balance with bitter-hot. Sour transforms from Wood, controlling Earth. Pungent overcomes Sour to prevent excess, so assist with sour-pungent. Bitter dries because Bitter transforms from Fire. Pale drains because Pale opens orifices. *Zang Qi Fa Shi Lun* says: Spleen suffers damp, urgently eat bitter to dry.) Damp upper excess with heat: Treat with bitter-warm. Assist with sweet-pungent. Stop when slight sweat restores normalcy.
(Damp stagnating upper Jiao forming heat: treat with bitter-warm. Bitter drains heat; Warm moves damp. Assist with sweet-pungent: Sweet harmonizes middle; Pungent disperses stagnation. Upper damp-heat stops with slight sweat restoring normal state.) Heat counteracts and prevails: Treat with bitter-cold. Assist with bitter-sour.
(Bitter-cold dispels heat. Heat excess consumes Yin fluids, so assist with bitter-sour.)

Shao Yang (Minister-Fire) governs the Heaven (Yin-Shen years). Fire excess prevailing: Balance with salty-cold. Assist with sweet-bitter. Use sour to gather, bitter to disperse, sour to restore. Same as heat excess.
(Water overcomes Fire, so balance with salty-cold. Bitter drains fire excess; Sweet relieves fire urgency, so assist with sweet-bitter. Fire flourishing and scattering: gather with sour. Fire stagnating and lurking: disperse with bitter. Dispersing fire hurts Qi, so restore with sour. Fire and heat treated together.) Cold counteracts and prevails: Treat with sweet-hot. Assist with bitter-pungent.
(If Qi is insufficient, same as above cold-overcoming-heat.)

Yang Ming (Dry-Metal) governs the Heaven (Mao-You years). Dryness excess prevailing: Balance with bitter-warm. Assist with sour-pungent. Use bitter to purge downward.
(Dryness is Metal Qi; Fire overcomes it, balance with bitter-warm (Bitter transforms from Fire). Assist with sour-pungent: Sour generates fluids; Pungent moistens dryness. Dryness knotting blocking, pathogen excess inside: purge downward with bitter.) Heat counteracts and prevails: Treat with pungent-cold. Assist with sweet-bitter.
(Pungent-cold moistens dryness and dissipates heat. Sweet-bitter drains fire and generates Metal.)

Tai Yang (Cold-Water) governs the Heaven (Chen-Xu years). Cold excess prevailing: Balance with pungent-hot. Assist with sweet-bitter. Use salty to drain.
(Pungent-hot scatters cold sufficiently. Sweet-bitter overcomes Water. Salty drains because Salty is Water's true flavor, draining uses salty.) Heat counteracts and prevails: Treat with salty-cold. Assist with bitter-pungent.
(If Qi is insufficient, heat counteracts and prevails. Treat with salty-cold to suppress Fire pathogen. Assist with bitter-pungent: Bitter drains heat; Pungent dissipates heat.)

Ju Yin (Wind-Wood) governs the Earth (Yin-Shen years). Wind excess inside: Treat with pungent-cool. Assist with sweet-bitter. Use sweet to relax, pungent to disperse.
(Treat with pungent-cool, assist sweet-bitter, sweet relaxes: same as Heaven governance above. Pungent disperses: Liver desires dispersion, urgently eat pungent to disperse.) Clearness counteracts and prevails: Treat with sour-warm. Assist with sweet-bitter. Use pungent to balance.
(Treat sour-warm, assist bitter-sweet: same as Heaven counteraction. Pungent balances: Sour is Wood's true flavor, tonifying uses pungent; Pungent is Metal's true flavor, draining uses pungent.) Shao Yin (Sovereign-Fire) governs the Earth (Mao-You years). Heat excess inside: Treat with salty-cold. Assist with sweet-bitter. Use sour to gather, bitter to disperse.
(Treat salty-cold, assist sweet-bitter, sour gathers: same as Heaven governance. Bitter disperses: Heat stagnating inside unresolved: disperse with bitter.) Cold counteracts and prevails: Treat with sweet-hot. Assist with bitter-pungent. Use salty to balance.
(Same as Heaven counteraction. Salty balances: Salty is Fire's true flavor, tonifying uses salty; Salty is Water's true flavor, draining uses salty.) Tai Yin Damp-Earth governs the Earth (Chen-Xu years). Damp excess inside: Treat with bitter-hot. Assist with sour-pale. Use bitter to dry, pale to drain.
(Same as Heaven governance.) Heat counteracts and prevails: Treat with bitter-cold. Assist with salty-sweet. Use bitter to balance.
(If Qi insufficient, Fire heat counteracts and prevails. Treat bitter-cold to suppress Fire. Assist salty-sweet: Salty-cold controls heat; Sweet-warm tonifies Earth. Bitter balances is same as bitter-cold.)

Shao Yang (Minister-Fire) governs the Earth (Si-Hai years). Fire excess inside: Treat with salty-cold. Assist with bitter-pungent. Use bitter to disperse.
(Minister-Fire fears Fire, so treat with salty-cold. Bitter drains fire; Pungent disperses fire, so assist. Gather with sour, disperse with bitter: meaning same as heat excess treatment above.) Cold counteracts and prevails: Treat with sweet-hot. Assist with bitter-pungent. Use salty to balance.
(If Qi insufficient, same treatment as heat governing Earth above.)

Yang Ming (Dry-Metal) governs the Earth (Zi-Wu years). Dryness excess inside: Treat with bitter-warm. Assist with sweet-pungent. Use bitter to purge downward.
(Dryness is Metal Qi...)