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If pathogenic factors are not eliminated and the disease lingers for a long time, it will inevitably lead to emaciation (severe wasting). Quack doctors, upon seeing this condition, indiscriminately use tonic prescriptions. They fail to realize that without pathogenic factors, there is no disease; once the pathogens are expelled, the healthy Qi (Vital Energy) can flow freely, so why worry about the inability to recover from deficiency? Now, by administering tonics, the pathogenic factors become more entrenched, and the healthy Qi becomes increasingly stagnant. The more stagnation, the more fever; the more fever, the more emaciation; the more emaciation, the more tonification; the more tonification, the more stagnation. This cycle continues endlessly until the patient dies, reduced to a skeleton, yet they still claim that despite taking several taels of Ginseng Radix et Rhizoma (Renshen), the deficiency could not be supplemented, attributing it to fate. The patient is misled for a lifetime, while the doctor remains oblivious, unaware that such practices have killed countless people.

When epidemic pathogens accumulate in the Mo Yuan (Membrane Source, a location between the exterior and interior) and contend with Wei Qi (Defensive Qi), fever persists day and night, slightly subsiding at Wu Geng (around 3-5 AM) and worsening at Ri Bu (around 3-5 PM). This resembles Dan Nue (Crimson Malaria, a type of malaria characterized by high fever). In Dan Nue, the heat is short-lived, disappearing after its peak, only to return at the same time the next day. In contrast, the heat of Warm Epidemic (Wen Yi) is prolonged, connecting head to tail throughout the twelve two-hour periods. The period between Yin and Mao (3-7 AM) marks the beginning and end of its heat. Even if residual heat lingers during these two hours, it appears as continuous day-and-night fever. Initially, when pathogens are stuck in the Mo Yuan, Qi combines to generate heat, but the Stomach itself is not diseased. Misusing cold-cooling herbs recklessly damages the vital energy; this is the first error. Later, when pathogens transmit to the Stomach, symptoms such as irritability, thirst, dry mouth, dry tongue with prickles, breath hot as fire, epigastric and abdominal fullness and distension, and afternoon tidal fever appear. These indicate a syndrome requiring purgation. If large doses of Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Zhi Zi (Gardeniae Fructus), and Huang Bo (Phellodendri Cortex) are used solely for clearing heat, one fails to understand that heat does not arise spontaneously. It is caused by pathogens in the Stomach obstructing the healthy Qi, leading to stagnation where Fire stays and accumulates into Heat. One must recognize that it is not merely Fire and Heat, but Heat generated due to Pathogens. A wise practitioner would administer Cheng Qi Decoction (Ordering the Qi Decoction) variants to expel pathogens. Once Qi moves, Fire dissipates, and Heat resolves naturally. Using cold-cooling herbs indiscriminately is like stirring boiling water to stop it from boiling. Many modern physicians favor Huang Lian Jie Du Tang (Coptis Decoction for Resolving Toxicity) and Huang Lian Xie Xin Tang (Coptis Decoction for Draining the Epigastrium), citing the *Su Wen* (Basic Questions): "When Heat dominates excessively, treat it with cold." They believe the Sage’s words cannot deceive them. Moreover, using cold herbs for heat diseases seems the quickest method, leaving no room for doubt. Whenever heat is severe, they blame Da Huang (Rhei Radix et Rhizoma) for purging and damaging Yuan Qi (Original Qi), claiming Huang Lian clears heat without harming Yuan Qi and avoids purgative risks, reassuring patients. Thus, for any heat syndrome, they prescribe large doses. If 2-3 qian are ineffective, they increase to 4-5 qian. If heat persists, they continue administration day and night, worsening the condition. Exhausted of skill and strength, they rationalize this as natural course. Seeing patients with long-standing disease whose abdominal skin adheres to the back indicates a Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction) syndrome. Yet, lacking fullness/distension, they dare not consider Cheng Qi formulas, instead aggregating cold herbs for clearing heat. Thinking no herb is colder than Huang Lian, they double the dose. The patient deteriorates daily. Due to uneliminated pathogens, delay leads to death. They claim taking several liang of Huang Lian failed to clear heat, blaming insufficient dosage, incurable disease, or fate. Tomorrow, encountering similar cases, they repeat this, even poisoning parents and wives, unaware that Huang Lian is bitter, cloying, cold, and drying. Like Da Huang, it is cold, but Da Huang moves and does not stay, while Huang Lian stays and does not move. One is drying, the other moistening; one is unblocking, the other obstructing—vastly different. Since treating epidemic pathogens requires unblocking throughout, using Huang Lian causes obstruction, preventing pathogen expulsion and root removal. How can one cure the disease without knowing the pathogenesis?

Question: Occasionally, some recover after taking Huang Lian. Why? Answer: Those individuals possess strong Zheng Qi (Upright Qi) and contracted mild pathogens initially. This is a self-healing case without medication. However, doctors mistakenly administered warm-tonic herbs, causing stagnation and heat. This transformed minor external heat into major internal heat. External heat arises from pathogen stagnation within the Zheng Qi realm and cannot be cured by Huang Lian. Internal heat results from mistaken warm tonification causing Zheng Qi stagnation and extreme heat, leading to irritability, thirst, insomnia, and delirium. This is not Zheng Qi heat but externally added heat by quacks. Huang Lian clears the seven parts of non-pathogenic internal heat. As heat decreases, Zheng Qi recovers. The remaining three parts of pathogenic external heat resolve as Qi flows. Doctors misunderstand this, believing Huang Lian was effective. Applying this universally to external heat later yields no effect. When previous efficacy fails now, they suspect severe underlying disease rather than recognizing their error, persisting in delusion and causing immense harm.

Question: Occasionally, those who did not suffer from mistaken warm tonification recover after taking Huang Lian. Why? Answer: When Yuan Qi overcomes the pathogen, treatment is easy; when the pathogen overcomes Yuan Qi, treatment is difficult. If Yuan Qi is strong, even mistaken treatment may not be fatal. If the pathogen is strong, slight mistakes are often fatal. Here, the person’s Yuan Qi was originally strong, and the contracted pathogen was mild. With surplus Zheng Qi sufficient to overcome the pathogen, small amounts of Huang Lian do not depress Zheng Qi. This is a minor adverse reaction, and recovery is fortunate due to strong Zheng Qi. Doctors, misunderstanding this, claim credit. Later, encountering cases where pathogens dominate, they fail to guide pathogens out. Mistakenly using Huang Lian causes obstruction, leading to danger.