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The method of using counter-assistance (Fan Zuo) in prescribing medication is the core principle of the medical theories of Huangdi and Qibo, a subtle and critical adaptive strategy in treating diseases, the rationale of which must be clearly understood. Why is it that later generations of physicians often borrow this method to disrupt established norms? Not only does this contradict logic initially, but it also leaves harmful consequences for posterity; thus, it is imperative to distinguish between correct and incorrect applications. Observing the discussions on treatment in the *Neijing* (Classic of Internal Medicine): "If an odd formula (Qi, referring to formulas with single-natured or fewer herbs) fails, use an even formula (Ou, referring to formulas with combined natures or more herbs); if an even formula fails, use counter-assistance to achieve the cure." This refers to cold, heat, warmth, and coolness treatments that follow the disease's manifestation. The meaning here implies that diseases vary in severity and may present true or false symptoms. One should first employ standard treatment (Zheng Zhi) via odd or even formulas; if standard treatment proves ineffective, then counter-assistance is employed. This is a necessary adaptation. Furthermore, the classics state: "For mild conditions, treat contrary to the disease nature; for severe conditions, treat in accordance with the disease nature." It also states: "Treating contrary to the disease nature is called Standard Treatment (Zheng Zhi); treating in accordance with the disease nature is called Counter-Treatment (Fan Zhi)." This means using cold medicines to treat heat diseases and hot medicines to treat cold diseases, opposing the pathogen's nature, is termed Standard Treatment; whereas using cold medicines to treat cold diseases and hot medicines to treat heat diseases, following the disease's apparent nature, is termed Counter-Treatment. For instance, when treating cold with hot medicine but the cold pathogen rejects the heat, one adds a small amount of cold medicine as counter-assistance to facilitate entry; when treating heat with cold medicine but the heat pathogen rejects the cold, one adds a small amount of hot medicine as counter-assistance to facilitate entry. These are all meanings of counter-assistance, representing necessary adaptations. Additionally, the classics say: "Hot medicines taken cold, cold medicines taken hot." Wang Bing commented: "Hot due to cold usage" refers to cases like severe internal cold accumulation requiring hot treatment. However, if extreme cold repels hot medicine preventing its action, the hot medicine should be taken cold. After swallowing, once the cold temperature dissipates, the hot therapeutic property activates. The patient's condition remains uncontradicted, yielding great benefit. This is the method of 'hot due to cold usage.' "Cold due to hot usage" refers to cases like severe internal heat where cold attack fails to penetrate and hot attack worsens the disease. Thus, cold medicine is taken hot. After entering the abdomen, once the heat dissipates, the cold therapeutic property acts. The condition harmonizes, and the disease diminishes. This is the method of 'cold due to hot usage.' All these instances illustrate the concept of counter-assistance in the *Neijing*.

Furthermore, Zhang Zhongjing treated diarrhea associated with Shaoyin syndrome by initially using Baitong Decoction (Bai Tong Tang), which is standard treatment. Later, due to the appearance of irritability, he switched to Baitong Decoction plus Porcine Bile and Pig Gallbladder (Bai Tong Jia Zhu Dan Ye Tang), which is counter-assistance. In treating Huoluan (cholera-like syndrome) with vomiting and diarrhea and a faint pulse nearing extinction, he initially used Sini Decoction (Si Ni Tang), which is standard treatment. Later, due to sweating and slight irritability, he used Tongmai Sini Decoction plus Porcine Bile and Pig Gallbladder (Tongmai Sini Jia Zhu Dan Ye Tang), which is counter-assistance. Similarly, Xue Lizhai treated Han Zitong's consumption fever, and I treated Wang Pengque's throat bi (sore throat/swelling), both employing this method.

However, the so-called counter-assistance practiced by various schools today is different. Let us briefly examine some contemporary popular examples. The works highly revered in recent times belong to Zhu Danxi. In treating acid regurgitation, Zhu Danxi invariably used Stir-fried Coptis Rhizome (Chao Huanglian, 炒黄连) as the sovereign herb, assisted by Evodia Fruit (Wuzhuyu, 吴茱萸). In treating heart and abdominal pain, he advocated doubling the dose of Gardenia Fruit (Shanzhizi, 山栀子) and assisting it with Stir-fried Dried Ginger (Chao Ganjiang, 炒干姜). I do not understand such practices. If the condition is indeed heat, cold medicine suffices; why add Dried Ginger and Evodia? If the condition is indeed cold, hot medicine suffices; why add Coptis and Gardenia? If the disease is mild and these are borrowed for their dispersing properties, efficacy might be seen, yet errors could still exist. If the disease is severe, patients will only observe worsening symptoms daily, unaware that they are suffering from contradictory cold-heat interventions, pulling in opposite directions, leading to constant hindrance and inevitable mistakes. Moreover, with such complex actions, determining efficacy becomes difficult, and distinguishing whether heat or cold is appropriate becomes ambiguous. This stems from unclear insight, leading to indecision, which is a major flaw in medical practice and should be self-reflected upon and strictly avoided.

Some argue: "Using hot to guide cold, and cold to guide heat, this perfectly aligns with the *Neijing*'s method of counter-assistance. People praise his skill, yet you deny it. How biased are you?" I reply: "This method is subtle and its application exquisite. Do you wish to hear the details? I shall explain thoroughly. The method of counter-assistance is an adaptive strategy in treatment. Confucians speak of constant principles (Jing) and adaptive measures (Quan); physicians likewise have Jing and Quan. Jing refers to daily constant laws; applying Jing is correct reasoning. Quan refers to situational flexibility; applying Quan is temporary adjustment. Both have their appropriate uses, grounded in necessity, leaving no room for arbitrary borrowing. The use of counter-assistance in herbs is also a form of Quan. It applies only outside standard principles, serving as a temporary measure necessitated by circumstances. It is not suitable for every prescription. So, what requires counter-assistance and what does not? Generally, those unresponsive to standard treatment require counter-assistance. Those whose pathology repels medication require counter-assistance. Cases of extreme fire resembling water require counter-assistance. Cases of extreme cold resembling heat require counter-assistance. True conditions are treated truly, false conditions are treated falsely. The interplay of opposition and conformity offers such profound utility. Assuming there is no pathological rejection or false presentation, standard treatment should naturally be used; why resort to counter-treatment? Using adaptability when inappropriate violates logic and normalcy; using counter-assistance when inappropriate leads to pathogen dominance and loss of healthy qi. How can these be mixed indiscriminately? Historically, Huangdi and Qibo introduced counter-assistance to establish the doctrine of Jing and Quan; later generations' misuse has merely opened doors to chaos. Its deviations include confusing right and wrong, blurring distinct symptoms, combining cold and heat indiscriminately, and mixing attacking and tonifying methods. Some even prescribe wildly, alternating ten doses of cold with one of heat, committing numerous errors while using this as an excuse. Without distinguishing these, practicing medicine becomes nearly impossible. Alas! The distortion of this doctrine has existed for a long time. Where can one find someone willing to listen to pure truths and discuss the way of seeking the root? Therefore, I place my hope in future generations and record these reflections on my own limited understanding. The above treatment methods of Zhang Zhongjing are recorded in the *Shanghan Lun* (Treatise on Cold Damage). Xue Lizhai's treatment of Han Zitong is noted in the Consumption section. My treatment of Wang Pengque is noted in the Throat Bi section."