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The key to treating diseases in Traditional Chinese Medicine (TCM) lies in prescribing medication for various contradictory syndromes; this is also where the advantage of TCM resides. Examples include mixed cold and heat, or mixed deficiency and excess. For instance, in a syndrome characterized by Yin deficiency accompanied by phlegm-dampness, nourishing Yin may hinder the resolution of phlegm, while resolving phlegm may damage Yin. In such cases, Jinshui Liujun Decoction (Jinshui Liujun Tang) can be used; adding Danggui (Radix Angelicae Sinensis), Shengdi (Radix Rehmanniae Preparata), and Yuanshen (Radix Scrophulariae) to Erchen Tang (Erchen Tang), a formula for resolving phlegm, allows for simultaneous nourishment of Yin and resolution of phlegm. Similarly, when eczema is complicated by diarrhea, stopping diarrhea may hinder the treatment of the rash, while treating the rash may hinder stopping the diarrhea. Using Ziyin Xuanjie Decoction (Ziyin Xuanjie Tang) achieves both goals effectively. Another example is Chaihu Jia Mangxiao Tang (Chaihu Jia Mangxiao Tang), where Renshen (Radix Ginseng) and Mangxiao (Natrii Sulfas) are used together; Lizhong Jiada Huang Tang (Lizhong Jiada Huang Tang), where Ganjiang (Rhizoma Zingiberis) and Dahuang (Radix et Rhizoma Rhei) are combined; and various Xixin Decoctions (Xixin Tangs), where Ganjiang and Renshen are used alongside Huanglian (Rhizoma Coptidis) and Huangqin (Radix Scutellariae). There are many such methods that apply tonification and purgation simultaneously, and combine cold and warm properties. The key lies in carefully distinguishing which aspect of the mixed syndrome is predominant and which is minor, and reflecting this reasonably in the dosage of medications, so that these contradictory syndromes can be resolved smoothly.

Examine syndromes with meticulous detail, precisely analyzing the proportion of mixed factors; prescribe medications accurately, weighing every minute dose.

Old Li believes that the guiding core of TCM academic thought is materialist dialectics. Therefore, we must always use materialist dialectics as our guiding ideology to study TCM. He stated: "Materialist dialectics has three components: the law of unity of opposites, the law of transformation of quantity into quality, and the law of negation of the negation. Within these lie the viewpoint that practice is primary, the importance of investigation and research, and the emphasis on identifying various contradictions and finding the principal contradiction. The guiding ideology of TCM precisely requires these aspects. Therefore, we must purposefully and consciously apply materialist dialectics to the research and clinical practice of TCM." In his clinical scientific research work, he often warned us: When clinically examining diseases, one must be comprehensive and detailed, paying attention to medical history and objective indicators, never being misled by false appearances. One must be adept at identifying the decisive factors amidst chaotic and complex syndrome manifestations, determining the proportional relationships among various complex causes, distinguishing between the root (ben) and branch (biao), and deciding which treatments should be delayed and which should be urgent. He would often ponder repeatedly over adding or subtracting a single herb, or adjusting a dose by a tiny amount, and sometimes think for days about the presence or absence and degree of pathogenic factors and mechanisms, only feeling satisfied once the problem was identified. He once cited a case of a patient with worsening rheumatic heart disease and heart failure to illustrate the importance of purposefully and consciously applying materialist dialectics. He said: "A 29-year-old female patient suffered from rheumatic heart disease, mitral stenosis and insufficiency, and total heart failure. After treatment with both Western and Chinese medicines, she improved rapidly, but suddenly developed shortness of breath, edema, and worsened dyspnea. Western medicine diagnosed pulmonary infection and heart failure. Emergency treatment included antibiotics, digoxin, and Zhenwu Tang (Zhenwu Tang) modified with heat-clearing and detoxifying herbs. After 10 days, not only did symptoms not subside, but they worsened. I was invited to consult. Upon examination, the syndromes clearly matched Zhenwu Tang indications. I prescribed Zhenwu Tang modified for two doses, but there was no effect. Re-examining the pulse and symptoms, there were no special findings. Carefully observing her environment, I noticed her bed was placed right next to a door. I realized: she had been exposed to cold wind leaking through the door gap. We immediately moved the bed and placed a screen beside it to prevent further exposure. Simultaneously, I added small amounts of Xixin (Radix Asari) and Mahuang (Herba Ephedrae) to Zhenwu Tang to dispel wind-cold. The next day, her condition significantly improved." He often said: The history of TCM development is essentially the history of applying materialist dialectics to medicine. Therefore, our study of TCM must begin with the purposeful and conscious application of materialist dialectics and deepen from there. Regarding the discussions in Neijing (The Inner Canon of the Yellow Emperor) on the relationship between climate, human activities, geography, and disease onset, as well as the significance of observation and listening/smelling in diagnosis; the discoveries in Shanghan Lun (Treatise on Cold Pathogenic Diseases) and Jingui Yaolue (Essential Prescriptions from the Golden Cabinet) regarding abdominal palpation and pulse diagnosis; how to use abdominal palpation, pulse diagnosis, and syndrome comparison to examine syndromes; the significance of pulse examination by Zhang Jingyue, Li Shizhen, and Wang Shuhe; and Ye Tianshi’s methods of tongue inspection, tooth examination, and differentiation of macules, papules, and milia—all these represent deepening diagnostic methods, yet there is no difference in their application of dialectics. Thus, whether in clinical practice or research, we must adhere to materialist dialectics as our guiding ideology.

Early minor illnesses deserve particular attention; a dike of a thousand miles collapses due to an ant hole.

Old Li believes that people often focus on researching major and severe diseases while neglecting the treatment of minor and mild illnesses. For example, minor illnesses like common colds or acute bronchitis are often treated casually by doctors who do not pay enough attention, simply combining a few herbs without concern for rapid cure. Consequently, some heal naturally, while others evolve into major or severe diseases.

Old Li emphasized: Minor and mild illnesses generally present more frequently with excess syndromes and exterior syndromes, making them easier to treat. However, if cold and heat are not distinguished, or deficiency and excess are unclear, treatment can often lead to serious consequences. For instance, mistaking an exterior syndrome for an interior syndrome and using heat-clearing and purgative methods often causes exterior pathogens to penetrate inward, failing to resolve the exterior. Treating an exterior cold syndrome as an exterior heat syndrome can cause exterior cold to become trapped, leading to intensified interior heat. Conversely, treating an exterior heat syndrome as an exterior cold syndrome can exacerbate pathogenic fire. If a patient has Qi deficiency with exterior cold, failing to release the exterior will inevitably damage healthy Qi, leaving the exterior cold unresolved. If a patient has Yin deficiency with exterior heat, using acrid-warm sweating methods will damage Yin fluids, failing to eliminate the pathogen. Furthermore, in acute diarrhea complicated by interior excess and stagnation, if one sees diarrhea and uses astringent methods, it will cause pathogens to linger, resulting in either persistent diarrhea or chronic diarrhea. Dysentery, especially acute cases, is often caused by damp-heat and stagnation. However, knowing only the heat aspect or attributing it solely to bacillary dysentery, and overusing bitter-cold detoxifying herbs, often transforms the syndrome into chronic dysentery due to deficiency-cold. Acute bronchitis can be caused by wind-cold, wind-heat, cool-dryness, hot-dryness, or fluid retention. Clinically, differentiating and treating these specifically often leads to quick recovery; failing to distinguish cold from heat often results in retained fluids and dry coughs that persist for a long time. Early-stage acute nephritis is mostly due to external wind pathogens, requiring exterior-releasing and wind-dispersing treatments. However, wind can be cold or heat, and medicines can be acrid-cool or acrid-warm. Some doctors ignore this, merely using diuretics and heat-clearing detoxifiers, causing exterior pathogens to remain, penetrate inward, or worsen cold, leading to Yang failing to transform water, resulting in complicated syndromes that drag on for years. In ophthalmology, keratitis in the acute stage can be cured quickly if one distinguishes between wind-cold and wind-heat. However, some doctors only know to use heat-clearing detoxifiers and leukoderma-resolving drugs, resulting in ulcers that are difficult to eradicate. Such examples are too numerous to list. Therefore, we must pay attention to minor and mild illnesses in clinical practice. Zhang Zhongjing and Wu Jutong are considered masters not only for other reasons but primarily because they attached great importance to the treatment of minor and mild illnesses.

Stubborn diseases complicated by new infections: Treating the branch (symptoms) takes precedence over the root (cause).

Old Li believes that the worsening of many diseases, particularly severe ones, is related to new pathogenic factors. These factors generally fall into four categories: first, exogenous Six Evils (Six Exogenous Pathogens); second, food stagnation; third, emotional injuries (Seven Emotional Injuries); fourth, incorrect medication. If clinicians do not pay attention to these four factors and simply attribute deterioration to the inherent disease, satisfactory results are rarely achieved. For example: A lung cancer patient, Mr. Li, suddenly experienced severe pain in his left arm. Family members and some doctors believed it was due to metastasis. Old Li was consulted. Through repeated inquiry into medical history and pulse analysis, he concluded it was caused by wind-cold and unrelated to lung cancer. However, considering that most drugs for frozen shoulder (Jian Ning) were ineffective for lung cancer, he suggested acupuncture treatment, which stopped the pain quickly. Another example: A patient with sequelae of cerebral thrombosis. Old Li initially treated him with modified Buyang Huanwu Tang (Buyang Huanwu Tang), and all symptoms improved. On a subsequent visit, symptoms worsened significantly. Examining the pulse and symptoms, Old Li said: "This is not a worsening of the chronic disease, but due to Liver Qi stagnation." He prescribed several doses of modified Xiaoyao San (Xiaoyao San), and the symptoms indeed subsided. Why Xiaoyao San? Because the patient's face showed a depressed expression, his family members also appeared unhappy, and his pulses suddenly became deep. Knowing it was caused by depression, he treated it with modified Xiaoyao San.

Diagnosing diseases focuses on objective signs; principles, methods, formulas, and herbs require step-by-step deep investigation.

Old Li believes that Chairman Mao's emphasis on investigating and researching, conducting careful and comprehensive investigations, and mastering first-hand materials is very correct. Doctors should handle problems according to this viewpoint. He said: "In clinical practice, we should fully utilize our eyes, ears, mouth, nose, and hands to understand all issues related to the disease. We must never rely on hearsay as the basis for understanding or solving problems." For example, some patients exaggerate their condition, others minimize it, and some patients or families describe their condition based on erroneous medical knowledge. He once treated a patient who complained of persistent high fever. Chest fluoroscopy indicated pneumonia, and the patient requested a prescription from Old Li. Old Li examined the pulse as floating and tight, noted headache and body ache, aversion to cold, and dry mouth, diagnosing it as exterior cold with interior heat. He prescribed one dose of Da Qinglong Tang (Da Qinglong Tang), and the patient recovered. If he had not personally examined the pulse and confirmed the syndrome, he might have prescribed Maxing Shigan Tang (Maxing Shigan Tang) plus Yinhua (Flos Lonicerae Japonicae) and Lianqiao (Fructus Forsythiae) like the previous doctor, which would not have been effective. Old Li once recounted: While practicing in Lingqiu, he encountered many patients with cold damage syndromes. Upon examination, their conditions matched the Mahuang Tang syndrome described in Shanghan Lun exactly. He prescribed the original Mahuang Tang formula, but none responded. He then went to the pharmacy himself to inspect the herbs used and discovered that the Ephedra (Mahuang) had been stored for several years. He wondered if the freshness of the herb made a difference. He immediately went to the wild, collected fresh Ephedra, and applied it. All patients recovered after one dose. Facts prove that personally examining and mastering first-hand data is essential for diagnosing and treating diseases.

Confirming syndromes and prescribing medications requires seizing unique characteristics.

Old Li believes that Chairman Mao stated in "On Contradiction" that one must be good at grasping specificity, and Zhang Jingyue told us in "Jingyue Quanshu" to be good at grasping uniqueness. Therefore, in clinical medication, we should also focus on "uniqueness." For example, in epigastric pain, hunger pain indicates deficiency; postprandial pain indicates excess; pain after drinking indicates fluid retention; pain after eating spicy food indicates heat; night pain indicates blood stasis; pain after anger indicates Liver Qi stagnation and knotting; pain during mental exertion indicates Spleen deficiency. When grasping uniqueness, it is sometimes difficult to distinguish unique aspects, as focusing on one feature might resemble another. What should be done? Old Li said: "Be good at seeking specificity through comparison. For example, a deep and fine pulse could indicate Qi stagnation, or it could indicate dual deficiency of Qi and Blood, or dual deficiency of Yin and Yang. How should one recognize it? One must look to complexion and abdominal palpation. If the complexion is sallow and the abdomen is soft, the deep and fine pulse indicates Heart and Spleen insufficiency with dual deficiency of Qi and Blood. If the complexion is dark and the lower back feels heavy, it indicates dual deficiency of Kidney Yin and Yang. If the complexion shows depression, it indicates Liver Qi stagnation. Similarly, in hemiplegia, if the pulse on one side is larger, consider dual deficiency of Qi and Blood. If both pulses are deficient, large, and floating, and the face is not red, it indicates dual deficiency of Qi and Yin with phlegm-heat obstruction. Clinical medication must strive for accuracy. Be good at using targeted formulas and herbs according to the specificity of the syndrome. Do not arbitrarily add uncertain herbs or formulas. Only write the prescription after ensuring complete consistency between principles, methods, formulas, and herbs."

Difficult and critical cases prioritize abdominal palpation.

Old Li places great importance on abdominal palpation when diagnosing critical diseases and diseases related to the abdomen. He said: "Abdominal palpation is the key to determining deficiency/excess, cold/heat, exterior/interior, and disease location." He believes that generally, tenderness indicates excess, while preference for pressure indicates deficiency. Fullness without tenderness indicates Qi stagnation; tenderness in a small area below the xiphoid process indicates phlegm-excess; tenderness throughout the epigastrium indicates gastric stagnation; worsening cough and asthma upon pressing the epigastrium indicates cold-phlegm congealing in the Spleen and Stomach; tenderness in the left hypochondrium indicates Liver cold; tenderness in the right hypochondrium indicates excess-heat or phlegm-excess; pain beside the umbilicus with mild tenderness indicates Liver Qi stagnation with collateral stasis or Liver cold-stagnation; umbilical pain with mild tenderness indicates Spleen-Kidney deficiency-cold; umbilical pain varying in intensity or migrating indicates roundworms. Lower abdominal distension without pain indicates lower Jiao Qi stagnation, possibly in the Bladder, Large Intestine, or Liver-Kidney system; distension with tenderness indicates Qi stagnation and blood stasis, or cold coagulation and Qi knotting. Pain in one or both sides of the lower abdomen belongs to the Liver; tenderness therein indicates Qi-Blood stasis or cold-blood stagnation; lack of tenderness indicates Qi stagnation. Severe pain across the entire abdomen that refuses pressure often indicates abscess, chest binding, or organ knotting; if pain is not severe but hardness is felt upon pressure, it indicates water or blood stasis congealment. Additionally, pain radiating to the chest and heart belongs to Heart-Spleen; pain radiating to the hypochondrium belongs to Liver-Gallbladder; pain radiating to the waist belongs to the Kidney.

Old Li emphasizes that the abdomen is the residence of the Spleen, Stomach, Liver, and Kidney, and is the hub of Qi and Blood ascending and descending. If Qi does not ascend and descend, one is either ill or dead; therefore, critical diseases must involve abdominal examination. He said: "Patient Li suffered from epidemic encephalitis B, with high fever and coma for five days. Treatment with Western medicine and modified Qingwen Baidu Yin (Qingwen Baidu Yin) plus Angong Niuhuang Wan (Angong Niuhuang Wan) failed. Careful examination revealed hard pain in the upper abdomen. I prescribed modified Da Chengqi Tang (Da Chengqi Tang). After one dose, consciousness returned, fever subsided, and the patient recovered. Another example: A shock patient whose blood pressure did not rise despite large doses of Dushen Tang (Dushen Tang) combined with Western medicine. Upon palpating tenderness in the epigastrium, I prescribed Zhishi (Fructus Aurantii), Houpo (Cortex Magnoliae Officinalis), Erchou (Semen Pharbitidis), and Renshen, and the patient recovered. Facts prove that without abdominal palpation, one cannot know deficiency/excess or exterior/interior, and treatment will inevitably fail. Therefore, abdominal palpation is mandatory for critical diseases."

Old Li emphasized eight points to note during abdominal palpation:
1. Location of onset and specific reactive areas: Hypochondrium, beside the umbilicus, and both sides of the lower abdomen belong to the Liver; below the xiphoid process belongs to the Lung, Stomach, and Heart; the epigastrium belongs to the Heart, Spleen, and Stomach; the entire abdomen belongs to the Spleen; the lower abdomen (near Guanyuan CV-4) belongs to the Kidney, Bladder, and Chong and Ren vessels; the center of the umbilicus belongs to the Spleen and Kidney.
2. Pain: Preference for pressure indicates deficiency; refusal of pressure indicates excess; pain that migrates upon pressure indicates Qi; relief with warmth indicates cold; pain with distension indicates Qi stagnation; pain without distension indicates blood stasis or deficiency-cold; pain with softness indicates deficiency; pain with abdominal muscle tension indicates excess; pain with a mass indicates cold coagulation and Qi knotting; pain that feels cold indicates cold; pain that feels hot indicates heat or blood stasis.
3. Masses: Hard and immovable masses indicate blood stasis; soft and immovable masses indicate phlegm-dampness; masses that appear and disappear intermittently indicate cold coagulation and Qi stagnation.
4. Distension and fullness: Epigastric stuffiness without external enlargement is Pi (痞, blockage), indicating mixed cold and heat; external enlargement indicates Qi stagnation; tenderness indicates excess; hardness like a solid plate indicates cold-phlegm. Generalized abdominal fullness indicates Spleen-Stomach Qi stagnation. Subjective lower abdominal fullness without external enlargement indicates blood stasis. Lower abdominal distension indicates lower Jiao cold coagulation and Qi stagnation. Tightness and slight distension on one side of the lower abdomen indicate Liver Qi stagnation. Lower abdominal fullness with difficulty urinating indicates Bladder Qi stagnation. Distension in the hypochondrium or one side of the umbilicus indicates Liver Qi stagnation. Abdominal fullness that does not decrease, even slightly, indicates excess; abdominal fullness that fluctuates in severity indicates cold-dampness or deficiency-cold. Fullness from afternoon to early night indicates Spleen-Kidney deficiency-cold; fullness throughout day and night indicates excess-heat. Worsening fullness after anger indicates Liver Qi stagnation. Abdominal fullness on windy days indicates wind-pathogen penetrating inward; abdominal fullness before cloudy days improving after sunny days indicates dampness.
5. Ascites: Soft upon pressure indicates more Qi than water; harder upon pressure indicates less Qi and more water. Visible veins on the abdomen indicate blood stasis. Abdominal enlargement with muscle tension, protruding umbilicus, and wider lower than upper part indicates Kidney involvement. Abdominal enlargement preventing self-turning, with hypochondriac pain, indicates Liver involvement. Heavy body, shortness of breath, inability to lie down, and irritability indicate Heart involvement. Abdominal enlargement with heavy limbs indicates Spleen involvement. Abdominal distension that is tight upon pressure is difficult to treat.
6. Abdominal muscle tension: Soft and thin upon pressure indicates deficiency; tight, hard, and thick indicates phlegm-dampness; cord-like or patchy hardness indicates cold or stasis. Tension in the lower abdomen indicates blood stasis; tension in the upper abdomen mostly indicates Qi stagnation.
7. Abdominal temperature: Heat upon pressure indicates accumulation, dampness, phlegm, or heat generated from food stagnation; cold indicates cold. Self-sensation of burning in the stomach indicates mixed cold and heat; burning in the lower abdomen indicates Kidney deficiency with damp-heat; burning in the hypochondrium indicates Yin deficiency with blood stasis.
8. Palpitations: Epigastric palpitations indicate Heart or Heart-Spleen deficiency. Sub-umbilical palpitations indicate Water Qi Ben Tun (water qi rushing upward).

Differentiating oral sensations, emphasizing detailed observation.

Oral sensations mainly include thirst and taste, belonging to subjective feelings. However, oral sensations produced by pathological reasons hold significant value for diagnosing diseases.
1. Thirst
Thirst is a common clinical symptom visible in various disease processes. It is also an important component of TCM inquiry. Even though it is thirst, the main syndrome differs based on the characteristics of the thirst. Therefore, in clinical differentiation and treatment, and in prescribing medications, careful observation is indispensable.
(I) No thirst, no desire to drink
This can be seen in the following situations:
1. Yin Syndrome: Non-Yang syndrome.
2. Cold Syndrome: Often caused by contracting cold pathogens, damaging Yang Qi. Symptoms include aversion to cold, preference for warmth, cold limbs, curling up to sleep, and slow, tight pulse. Treatment should use Lizhong Tang (Lizhong Tang).
3. Dampness Syndrome: Exterior dampness must be accompanied by a thin, white, slippery tongue coating and floating, soggy, slow pulse. Treatment should use Guizhi Jia Fuzi Tang (Guizhi Jia Fuzi Tang). Interior dampness (internal damp-fluid, phlegm-turbidity) must be accompanied by a thick, white, slippery tongue coating and deep, slow, string-taut, fine pulse. Treatment should use Erchen Tang (Erchen Tang).
4. Cold Damage Taiyang Syndrome: Has not entered Yangming.
5. Warm Disease pathogens in Ying (Nutrient) level, not Qi (Energy) level: Although the tongue is dry and crimson, thirst is not severe. When pathogenic heat moves from Qi to Ying, heat rises with Ying Qi, causing lack of thirst. Even if thirsty, intake is small. Symptoms may include evening feverishness, restlessness, faint macules/papules, and crimson tongue. Treatment should clear Ying and cool blood, selecting Qingying Tang (Qingying Tang) etc.
(II) Thirst with desire to drink
This can be seen in the following situations:
1. Yang Syndrome: Non-Yin syndrome.