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Inspection involves observing the patient's complexion and physical form. Auscultation and olfaction involve listening to the patient's voice. Inquiry involves asking about the condition of the illness. Palpation involves examining the six pulses. These four methods are originally indispensable, yet inspection and inquiry are the most crucial. Why? Because auscultation merely assesses the pitch of the voice to determine Deficiency (Xu) or Excess (Shi), and the quality of coughing—whether stifled or clear—to determine the movement of Qi (ascending or descending). There is little else to hear. Regarding pulse diagnosis, it merely distinguishes floating and sinking pulses to determine Exterior (Biao) or Interior (Li), slow and rapid rates to determine Cold (Han) or Heat (Re), and strong and weak forces to determine Deficiency or Excess. Other aspects may be clear in mind but difficult to discern under the fingers. Moreover, pulses can vary in size from large to small, appearing suddenly floating or suddenly sinking, making the six pulses hard to standardize. Therefore, the claim by some physicians that "symptoms can be determined solely by the pulse" is a deceptive argument. Only by carefully inquiring into the cause can one know the origin of the disease; by carefully inquiring into recent conditions, one can know the depth of the disease. By inspecting the color of the affected area, the lips, the tongue, and the urine and stool, one has grasped eight or nine-tenths of the clinical picture. Then, palpating the pulse and combining it with the information from inquiry and inspection, one checks for consistency. If any doubt remains, one silently reflects on the reasons, comparing Deficiency with Excess, Cold with Heat, and Exterior with Interior. There will naturally be a point of certainty, allowing for a diagnosis. Practicing this art with caution ensures no errors.

Generally, human diseases do not go beyond Yin and Yang. The differentiation of Yin and Yang is summarized entirely by the six characters: Exterior, Interior, Deficiency, Excess, Cold, and Heat. Interior belongs to Yin, Exterior belongs to Yang; Deficiency belongs to Yin, Excess belongs to Yang; Cold belongs to Yin, Heat belongs to Yang. A skilled physician saves lives merely by distinguishing these Yin and Yang aspects. An incompetent physician causes death merely by misidentifying these Yin and Yang aspects. For instance, if there are symptoms of fever with aversion to cold, nasal congestion, coughing, headache, floating pulse, tongue without coating, and no thirst, this is an Exterior syndrome. If there are tidal fever with aversion to heat, dry mouth, yellow tongue coating, abdominal pain with difficult bowel movements, and a sinking pulse, this is an Interior syndrome. If there is shortness of breath, physical weakness, excessive sweating, palpitations, guarding the heart and abdomen, cold limbs, and a powerless pulse, this is a Root Deficiency syndrome. If during the illness there is no sweat, or mania/restlessness preventing sleep, abdominal distension with refusal to press, and a solid and forceful pulse, this is another type of Excess syndrome. If the lips and tongue are white, there is no thirst, a preference for hot drinks, clear runny nose, clear urine, loose stools, cold hands and feet, and a slow pulse, this is a Cold invasion syndrome. If the tongue is red, eyes are red, there is thirst with a preference for cold drinks, irritability, scanty dark urine, constipation, or dry lips and cracked tongue, this is a Heat syndrome. All these are differentiations of Yin and Yang. As for conditions such as excess pathogen with deficient healthy Qi, or Yin deficiency with hyperactive Fire, these represent Yin within Yang and Yang within Yin. The difference between them is like a hair's breadth versus a thousand miles, and life hangs in the balance. How can those who differentiate them not be cautious?

The treatment for Exterior syndromes should favor dispersing methods. For example, upon initial contraction of Wind-Cold, presenting with fever and headache, use only Perillae Caulis (Sugeng) 1.5 qian, Schizonepetae Herba (Jingjie) 1.5 qian, Saposhnikoviae Radix (Fangfeng) 1 qian, Ligusticum Chuanxiong Rhizoma (Chuanxiong) 1 qian, Glycyrrhizae Radix et Rhizoma (Gancao) 0.5 qian, and two slices of Zingiberis Rhizoma Recens (Shengjiang) to disperse. If the headache is severe, add Notopterygii Rhizoma et Radix (Qianghuo) 0.6 qian. If there is nasal congestion or clear rhinorrhea, add Pinelliae Rhizoma Preparatum (Banxia) 1.5 qian, Poria (Fuling) and Citri Reticulatae Pericarpium (Chenpi) each 1 qian. If there is coughing, add Platycodonis Radix (Jiegeng) 0.7 qian, Armeniacae Semen Amarum (Xingren) 3 qian, and Peucedani Radix (Qianhu) 1 qian, etc. After one dose, if sweating occurs and fever subsides, no further administration is needed; simply avoid wind and cold, and avoid greasy food. If sweating does not occur, administer a second dose and then stop. If there are alternating chills and fever, resembling malaria, use Bupleuri Radix (Chaihu) 0.8 qian, Scutellariae Radix prepared with wine (Huangqin) 0.8 qian, Paeoniae Radix Rubra (Chishao) 1 qian, Pinelliae Rhizoma Preparatum (Banxia) 1.5 qian, Glycyrrhizae Radix et Rhizoma (Gancao) 0.5 qian, three Jujubae Fructus (Dazao), and three slices of Zingiberis Rhizoma Recens (Shengjiang) to harmonize. For deficient patients, add Codonopsis Radix (Dangshen) 2 qian. Since the syndrome is at the Exterior, do not recklessly use digestive agents such as Aurantii Fructus (Zhike), Massae Fermentatae Medicinalis (Shenqu), or Hordeum Germinatum (Maiya) to avoid drawing the pathogen inward.

The treatment for Interior syndromes should focus on directing herbs to the meridians/organs. There are Deficiency and Excess, Cold and Heat; one must distinguish which Zang-Fu organ is affected and treat accordingly (see the Zang-Fu section for details). However, Joy, Anger, Worry, Overthinking, Sorrow, Fear, and Fright are called the Seven Emotions, which constitute the most difficult-to-treat Interior syndromes. One must soothe the mind for the medication to take effect; otherwise, it is useless. Furthermore, when symptoms are Interior, dispersing methods are strictly contraindicated. Dispersing will cause sweat collapse in Deficient cases and exacerbate Fire in Heat cases. It is terrifying that physicians often resort to Exterior-dispersing methods indiscriminately.

The treatment for Deficiency syndromes should favor tonification. There are Yin Deficiency and Yang Deficiency. Blood Deficiency is considered Yin Deficiency and requires blood tonification. For mild cases, use Rehmanniae Radix Preparata (Shengdi) 4 qian, Polygoni Multiflori Caulis (Shouwu) 2 qian, Angelicae Sinensis Radix (Guishen) 1.5 qian, Paeoniae Radix Alba prepared with wine (Jiushao) 1.5 qian, Testudinis Carapax et Plastrum calcined (Zhibiejia) 2 qian, Doupi 3 qian, Sea Cucumber (Haishen) 3 qian, and Glehniae Radix (Beishashen) 3 qian, etc. For severe cases, use Rehmanniae Radix Preparata (Shudi) 5 qian, Lycii Fructus (Gouqi) 3 qian, Schisandrae Fructus (Wuweizi) 0.7 qian, Corni Fructus (Yurou) 1 qian, and Cuscutae Semen (Tusizi) 1 qian to fill and nourish. Qi Deficiency is considered Yang Deficiency and requires Qi tonification. For mild cases, use Codonopsis Radix (Dangshen) 3 qian, Atractylodis Macrocephalae Rhizoma (Baizhu) 2 qian, Dioscoreae Rhizoma (Shanyao) 2 qian, Poria (Fuling) 1.5 qian, Glycyrrhizae Radix et Rhizoma calcined (Zhigancao) 0.6 qian, six Jujubae Fructus (Hongzao), and one slice of Zingiberis Rhizoma Recens (Shengjiang), etc. For severe cases, use Ginseng Radix et Rhizoma (Renshen) 1 qian and Astragali Radix (Huangqi) 1.5 qian to uplift. If Qi is about to collapse, add Aconiti Lateralis Radix Preparata (Fuzi) 2 qian and Zingiberis Rhizoma (Ganjiang) 2 qian to restore Yang. If both Qi and Blood are deficient, tonify both Yin and Yang simultaneously; Ba Zhen Tang (Eight Treasures Decoction) and Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction) are excellent formulas.

The treatment for Excess syndromes should favor purging/draining. Heart Fire Evil, Lung Wind-Cold, Spleen Food Stagnation/Parasitic Obstruction/Damp-Heat, Liver Qi Stagnation due to Anger, and pathogens affecting the Gallbladder, Stomach, Pericardium, Bladder, Large Intestine, and Small Intestine all constitute Excess syndromes. Treatment methods are detailed in the respective Zang-Fu sections. However, treating Excess requires speed; if delayed, the pathogen remains while Healthy Qi becomes deficient, making digestion/purging difficult.

The treatment for Cold syndromes should favor warming. Cold at the Exterior presents with aversion to wind and cold; use Perillae Folium (Suye) 1 qian, Agastaches Herba (Huogeng) 2 qian, Schizonepetae Herba (Jingjie) and Saposhnikoviae Radix (Fangfeng) each 1 qian, Peucedani Radix (Qianhu) 1.5 qian, Armeniacae Semen Amarum (Xingren) 3 qian, and three slices of Zingiberis Rhizoma Recens (Shengjiang) to disperse the pathogen. In severe cases, add Cinnamomi Ramulus (Guizhi) 0.5 qian, Ephedrae Herba (Mahuang) 0.5 qian, and Asari Radix et Rhizoma (Xixin) 0.6 qian. Cold at the Interior presents with a preference for hot drinks; use Pinelliae Rhizoma Preparatum (Banxia) 2 qian, Agastache Herba (Huoxiang) 1.5 qian, Atractylodis Macrocephalae Rhizoma fried (Jiaozhu) 1.5 qian, Magnoliae Officinalis Cortex preparated (Zhipu) 1 qian, Evodiae Fructus (Wuzhuyu) 0.8 qian, Hordeum Germinatum fried (Jiaoguya) 3 qian, Zingiberis Rhizoma baked (Weijiang) 2 slices, and Amomi Fructus (Sharen) 2 grains to warm the Middle. In severe cases, add Aconiti Lateralis Radix Preparata (Fuzi) 0.6 qian, Cinnamomi Cortex (Rougui) 0.6 qian, and Zingiberis Rhizoma (Ganjiang) 0.6 qian. In all Cold syndromes, the lips and tongue are white, the pulse is slow, bowels are loose, and the abdomen may be cold and painful. Administering Cold/Cooling herbs immediately leads to collapse. Be extremely cautious.

The treatment for Heat syndromes should favor cooling. However, Heat syndromes include Excess Fire and Deficient Fire. Excess Fire may result from external contraction or internal stagnation; treat according to the affected Zang-Fu organs. For mild Fire, use Gardeniae Fructus nigricans (Heishanzhi) 1.5 qian, Dendrobii Caulis (Shihu) 3 qian, Lycii Cortex (Digupi) 2 qian, Artemisiae Annuae Herba (Qinghao) 1.5 qian, Moutan Cortex (Danpi) 1 qian, Forsythiae Fructus (Lianqiao) 1.5 qian, Ophiopogonis Radix (Maidong) 2 qian, Trichosanthis Radix (Huafen) 1.5 qian, Lonicerae Japonicae Flos (Yinhua) 3 qian, Menthae Haplocalycis Herba (Zhuye) 0.5 qian, and Junci Medulla (Dengxin) a handful. For severe cases, add Coptidis Rhizoma (Huanglian) 0.7 qian, Scutellariae Radix (Huangqin) 1.5 qian, or Gypsum Fibrosum (Shigao) 4 qian and Anemarrhenae Rhizoma (Zhimu) 1.5 qian. For extreme cases, use Rhei Radix et Rhizoma (Dahuang) 1.5 qian and Gentianae Radix (Longdancao) 0.7 qian, etc. For Deficient Fire, if it is Yang Deficiency with exterior Heat (no thirst, non-red lips, non-rapid pulse), use Si Jun Zi Tang (Four Gentlemen Decoction) to tonify Yang. If it is Yin Deficiency with interior Heat (crimson tongue, possible headache, dry eyes, afternoon fever), use Si Wu Tang (Four Substances Decoction) or Liu Wei Di Huang Tang (Six Ingredient Pill with Rehmannia) to tonify Yin.