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Diseases may present as purely deficient or purely excess, requiring either tonification or purgation; where is there room for "Cheng Chu" (the balancing of deficiency and excess)? If one encounters a condition that is both deficient and excess, alternating between tonification and purgation requires careful consideration of whether to tonify first or purge first, the proportion of each, and whether the treatment should be slow or urgent, adjusting according to the specific syndrome.

Medical Case: Mr. Shen Qinglai from Wujiang, who became widowed young, had a history of frequent depression and anger, and suffered from hemoptysis (coughing up blood) occurring three to four times a year. After vomiting blood, he would recover without other symptoms, so he did not consider it a serious matter. In March, without any other cause, he suddenly developed slight fever, headache, and body pain. He did not have aversion to cold but had slight thirst. Aversion to cold with thirst indicates wind-cold invasion; however, no aversion to cold with slight thirst indicates epidemic pestilence (Yi). On the second day, his old condition flared up severely, with hemoptysis exceeding usual amounts, accompanied by dizziness, hand tremors, and irritability, manifesting various signs of deficiency-induced restlessness. He lost his appetite, and the fever gradually intensified. The physicians and the patient only saw the hemoptysis and assumed it was a recurrence of his old condition, unaware that it was an epidemic disease. Therefore, they attributed the fever to Yin deficiency and the headache and body pain to Blood deficiency. They failed to observe that these precursor symptoms had appeared the day before the hemoptysis, rather than being new symptoms added after bleeding. The physicians discussed using tonification and asked if I agreed. I said: Tonifying deficiency after blood loss can be acceptable as a temporary measure. This is because in cases of hemoptysis, there is stagnant blood internally obstructing the vessels, causing normal blood to fail to return to its channels, thus leading to bleeding. If the stagnant blood remains firm and unresolved, how can it be expelled? If the obstruction is removed, allowing free flow, the blood will naturally return to its channels, offering hope that it will not recur. However, if one specializes in tonification after bleeding, the interior will become full of blood; once full, it cannot return to the channels, and blood will overflow from the upper orifices. Using cold-natured herbs would be even more erroneous. Those administering tonics only focus on the immediate deficiency; using Ginseng may provide temporary relief but cannot eradicate the root cause, leading to future recurrences. Moreover, since there is also an epidemic pathogen, the situation differs from before. Now, the episode is triggered by the epidemic; blood loss causes deficiency, while the presence of the pathogen causes excess. This is a case of deficiency containing excess. If tonics are administered, initially, the excess fills the deficiency, gaining some benefit from tonification; subsequently, the excess fills the excess, leading to disaster. Thus, I temporarily used two qian of Ren Shen (Ginseng Radix et Rhizoma), assisted by Fu Ling (Poria), Dang Gui (Angelicae Sinensis Radix), and Bai Shao (Paeoniae Radix Alba). After two doses, the deficiency symptoms subsided, and the fever decreased by six or seven tenths. The physicians and patient believed the Ginseng was effective and wanted to continue rapidly. I could not stop them, so they continued recklessly. They then felt chest and epigastric oppression, abdominal discomfort, and a sensation of accumulated Qi, unable to belch. This Qi rose intermittently, causing nausea, distress in the epigastrium, general body discomfort, and insomnia throughout the night. They preferred massage and percussion. These are all changes indicating external excess syndromes. The reason is that there were only three parts of epidemic pathogen, which should produce only three parts of heat, but coincidentally, there were seven parts of deficiency. The meridians were dry and sluggish, and Yang Qi sank inward, resulting in ten parts of heat manifestation. Analyzed separately, this consisted of three parts excess heat and seven parts deficiency heat. Previously, when the vital Qi was empty, it did not struggle with the pathogen, so there were no excess symptoms. There was only internal restlessness (Ao Nu), dizziness, and vertigo due to weakness failing to resist the pathogen. Now, by administering tonics, the deficiency symptoms were reduced, and the fever decreased by six or seven tenths. The remaining three parts of heat are actually excess heat caused by the pathogen, which absolutely cannot be cleared by Ginseng. Taking Ginseng again now would instead aid the epidemic pathogen. The struggle between pathogen and healthy Qi resulted in the addition of excess change syndromes. Therefore, I administered a small amount of Cheng Qi Tang (Cathartic Decoction) to induce mild purgation, and the patient recovered. Note: If purgatives had not been used, resting quietly for a few days would also have led to recovery. Since his bowel movements occurred once every one to two days, it indicated that Stomach Qi was circulating, and the pathogen was inside, descending daily with the Stomach Qi, hence self-recovery. Some patients with regular bowel movements did not recover because there was dry stool hidden within, obstructing downward movement; recovery began only after expelling foul-smelling old stool. If the pathogen has not been eliminated and Ginseng is administered recklessly, the disease becomes more entrenched. Over time, if not resolved, physicians seeing gradual emaciation might diagnose it as Qie Zheng (Timidity Syndrome/Deficiency Consumption). Further tonification increases danger, and many die. In short, true Qie Zheng is rare in the world; those suffering from it nowadays are largely caused by Ginseng. In recent times, the price of Ginseng is like gold, making consumption inconvenient; therefore, this condition rarely arises in poor families but mostly in wealthy households.