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Physicians employ both fixed rules and flexible methods. Following ancient traditions requires adherence to principles without deviation, while applying flexible methods demands adaptability to changing circumstances without rigidity. Ancient prescriptions are tailored to patients' conditions, possessing inherent rationale. The selection of herbs and their dosages strictly follow the hierarchy of Sovereign (Jun), Minister (Chen), Assistant (Zuo), and Envoy (Shi) [Jun-Chen-Zuo-Shi], and should not be arbitrarily added or removed. The preparation of pills and powders, as well as the timing of administration, have specific key points.

Since the Heart and Lungs reside in the upper body and belong to Yang, treatments for Heart and Lung diseases require large pills for easy dissolution, or decoctions (Tang) and powders (San), or lozenges held in the mouth. These forms facilitate digestion. They must be taken after meals and before sleep, aiming to retain the medicinal qi within the Heart and Lungs. Conversely, the Kidneys and Liver reside in the lower body and belong to Yin. Treatments for Kidney and Liver diseases require small pills swallowed whole, bound with refined honey, wine paste, or beeswax to ensure slow release. They must be taken on an empty stomach in the morning, followed by dry food to press the medicine down, aiming to direct the medicinal qi directly to the Kidneys and Liver. The Spleen resides in the Middle Jiao (Central Earth). Medicines for the Spleen should be fine pills, such as water-pellets, steamed dough pellets, jujube meat pellets, or rice pellets, taken during the Si hour (9:00–11:00 AM, when hunger is moderate) so that the medicinal qi returns precisely to the Middle Jiao.

For acute conditions caused by Wind, Fire, Cold, or Summerheat, where rapid efficacy is desired, or for pathogens spreading to the exterior and four extremities, decoctions and powders are primary. "Decoction" implies sweeping away; it is chosen for its ability to cleanse and purge. "Powder" implies dispersing; it is chosen for its ability to scatter and diffuse. For chronic deficiency and wasting diseases that cannot be cured instantly, pills are primary. "Pill" implies slowness; it allows for gradual nourishment and support. Each category has a fixed standard.

It is commonly seen in popular practice that in pill formulas for Heart and Lung diseases, several herbs are reduced and replaced with those for Kidney and Liver diseases; conversely, in Kidney and Liver formulas, herbs are swapped for those treating Heart and Lung diseases. This confusion of upper and lower regions results in therapeutic failure. While wasting medicinal resources is a minor loss, delaying treatment leading to deeper disease is severe. In such cases, it is correct to divide them into two separate formulas, taken in the morning and evening respectively.

Diseases present as Cold or Heat, but there are also cases that appear Cold but are actually Heat, and vice versa, all requiring careful examination. The Classics state: Various restlessness, mania, wandering, fear, confusion, sadness, or inappropriate laughter belong to Heat. Wheezing, vomiting of sour fluid, sudden diarrhea with tenesmus, various lockjaw, teeth chattering, and shivering appear as Cold but are actually Heat; these are treated with cooling medicines. Discharges of fluids from above and below that are clear, transparent, and cold, accompanied by a bluish complexion and cold limbs, belong to Cold. A red face without fever, restlessness, thirst, yet a dislike for cold drinks, preferring to sit in mud or wells, appear as Heat but are actually Cold; these are treated with warming medicines. Excess Heart Qi generates Heat; Excess Kidney Qi generates Cold. Deficiency of Heart Qi allows Heat to attack internally; Deficiency of Kidney Qi allows Cold to move internally. This dictates that Heat is cleared, Cold is warmed, Deficiency is tonified, and Excess is purged.

Some initially contract Heat diseases but, due to excessive intake of cold agents and raw/cold foods, transform into Cold diseases. Others initially contract Cold diseases but, due to excessive intake of hot medicines and pungent-warm substances like Ginger and Sichuan Pepper, transform into Heat diseases. Ignorance of medication principles, specifically stopping treatment once the disease is addressed (Zhong Bing Ji Zhi), leads to over-treatment, adding new ailments to the patient.

If family members do not understand pulse diagnosis and wish to distinguish Cold from Heat, they may observe the patient's preferences. If the patient fears heat and fire, dislikes sunlight and warmth, feels thirsty and desires cold drinks, suffers from constipation, short and dark urine, mental restlessness, loud speech, insomnia, lies supine with extended limbs, and prefers cool sleeping places, these belong to Heat syndromes. If the patient fears cold and prefers warmth, has no dry mouth, desires hot drinks, has loose stools, long and clear urination, cold breath from nose and mouth, speaks little, and curls up in bed, these belong to Cold syndromes. Heat often indicates Excess, while Cold often indicates Deficiency. By inferring from this, Cold, Heat, Excess, and Deficiency can all be distinguished.