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Insufficiency of the Middle Qi (Middle Jiao Energy) leads to abnormalities in urination and defecation. The principles of Yin-Yang excess and deficiency are as such; how can one simply attribute all preceding symptoms to Excess-Heat? All pathological fluids that are clear, cold, and thin belong to Cold. "Fluids" refer to all discharges from the upper and lower orifices. Water is inherently clear and cold, and its nature is Cold; therefore, any vomiting or diarrhea where food is undigested and the discharge is clear and cold results from the transformation of Cold-Water, just as water becomes clear during the cold seasons of autumn and winter. Vomiting and acid regurgitation, sudden violent diarrhea with tenesmus, all belong to Heat. He-Jian Liu stated: Severe heat in the stomach and diaphragm causes vomiting, which is the manifestation of Fire flaming upward. Sourness is the flavor of Liver-Wood; when Fire is excessive and controls Lung-Metal, preventing it from balancing Wood, Liver-Wood becomes hyperactive, thus producing sourness. "Violent diarrhea" refers to sudden, severe watery stool. When intestinal and gastric heat is severe, transmission and transformation functions fail; due to the rapid nature of Fire, this occurs. "Tenesmus" refers to a feeling of urgency and pain in the rectum; the rapid and drying nature of Fire causes this. These explanations focus on Heat. However, the statement "all belong to Heat" refers to the root cause being Heat; regarding the fluctuations of Yin-Yang excess and deficiency, conditions can change drastically like ice and charcoal, so one cannot rigidly adhere to a single theory. For instance, the *Ju Tong Lun* states: When Cold pathogen invades the stomach and intestines, rebellious Qi surges upward, causing pain and vomiting. The *Zhi Yao Yao Da Lun* states: During the reign of Taiyang, people suffer from hematemesis and frequent belching; during the counter-reaction of Taiyang, Cold arises in the Heart and Stomach, causing chest discomfort, spitting of clear fluid, and hiccups/belching; during the dominance of Taiyang, Cold enters the Lower Jiao, leading to loose stools, etc. These are all diseases caused by excessive Cold. Furthermore, when Wood Qi is excessive, people suffer from incomplete digestion diarrhea and borborygmus, accompanied by hypochondriac pain and severe vomiting; in the Year of Fa Sheng, diseases manifest as vomiting and diarrhea, all caused by Wood pathogen attacking Earth and Spleen deficiency. When Earth Qi is insufficient, people suffer from incomplete digestion diarrhea and cholera-like syndromes; when Earth Qi is stagnant and erupts, it manifests as vomiting and profuse diarrhea; during the influence of Taiyin, cholera and vomiting/diarrhea occur, all caused by excessive Dampness affecting the Spleen. Some dampness transforms into Heat, while some shares the nature of Cold-Damp; Heat-Damp should be cleared with cooling methods, while Cold-Damp should be treated with warming methods, without violating the laws of Qi transformation. Regarding acid regurgitation, this section explicitly states it belongs to Heat; similarly, when Shaoyang wins, vomiting acid occurs, which is also a Minister-Fire syndrome, with no other theory attributing it to Cold. Only Li Dongyuan stated: In cases of vomiting acid water, if severe, the acid soaks the Heart; if mild, the acid is vomited out, causing the teeth to feel sour and astringent, unable to meet. Treating with major acrid-hot agents will reduce symptoms. Sourness represents the Qi of gathering, associated with the prosperity of West Lung-Metal. Cold-Water is the child of Metal; the child can make the mother full. Therefore, using major salty-hot agents to drain the child (Kidney-Water), assisted by acrid-hot agents to drain the excess of Lung-Metal, is correct. Using Liu Hejian's method to attack it as Heat would be an error. In miscellaneous diseases, acid regurgitation is due to turbid Qi failing to descend, intending to form middle-fullness; how can cold medicines treat this? Li Dongyuan's insight uniquely uncovered what predecessors had not expressed. Zhu Danxi asked: The *Su Wen* says acid regurgitation is Heat, but Dongyuan says it is Cold. Why? I replied: The *Su Wen* speaks of the root (Heat); Dongyuan speaks of the branch (Cold). However, Dongyuan did not mention external Wind-Cold but based his theory on gathering Qi to drain Lung-Metal excess; he claimed cold medicines cannot treat acid regurgitation, using An Wei Tang or Modified Er Chen Tang containing Ding Xiang (Clove), lacking methods for treating Damp-Heat stagnation, which does not fully align with classic intent. I once treated acid regurgitation using prepared Huang Lian (Coptis Rhizome) and Zhu Yu (Evodia Fruit) as佐使 (assistant-guiding herbs) according to seasons, with Cang Zhu (Atractylodes Rhizome) and Fu Ling (Poria) as assistants, formed into small pills with steamed dough, and advised patients to nourish themselves with vegetables and fruits, resulting in recovery. Thus, the two masters' views differ. In my opinion, although acid regurgitation has both Cold and Heat types, Cold is more common than Heat. Hence, Dongyuan used entirely warming medicines; Danxi, though using Huang Lian, also employed Zhu Yu and Cang Zhu, revealing the underlying logic. Generally, retained fluids in the Middle Jiao, stagnating for long periods, generate accumulation; dampness often generates Heat, causing Wood to transform via Fire, resulting in sourness—this is Heat-type acid regurgitation, treated per Danxi's method. If external Cold attacks the Stomach, turning sour instantly, it is not stagnation-Heat but clearly Cold; using cooling agents would be inappropriate. Also, irregular diet or spontaneous acid regurgitation and belching of rotten food indicate Wood flavor acting as pathogen, with Liver overacting on Spleen; Spleen's failure to transform is due to deficient Fire. Heat promotes movement; thus, it must be Cold. How can one avoid warming the Middle? Therefore, I side with Dongyuan and highlight this view, urging others not to assume all cases are due to Excess-Heat. Thus, the *Da Yao* states: Carefully observe the Pathogenesis (Bing Ji), assign each to its corresponding category; investigate the presence of symptoms, investigate their absence; address excess by examining its source, address deficiency by examining its origin; first understand the Five Phases' overcoming cycles, unblock Blood and Qi, ensure smooth flow, and achieve harmony. This is the principle. (The previous nineteen clauses constitute the Pathogenesis. "Ji" means essential point, change, and the origin of disease variation. Presence indicates Excess, absence indicates Deficiency. "Investigating" means seeking the root of presence/absence. Like searching for an object, finding its location makes retrieval easy. For example, Taiyin's humidity applies to Taiyang; Taiyang's cold applies to Shaoyin; Shaoyin's heat applies to Yangming; Yangming's dryness applies to Jueyin; Jueyin's wind applies to Taiyin. What overwhelms me is my Excess (True Pathogen); what overwhelms others is my Deficiency (False Pathogen). These six Qi's excess/deficiency correspond to presence/absence. Heaven and Earth's luck divides into Five Movements and Six Qi, but Yin-Yang function lies in Water and Fire. Thus, Yang excess harms Yin, Yin excess harms Yang. Draining excess addresses "presence"; tonifying decline addresses "absence". Finding the root and exploring deeply resolves difficulties easily. Without understanding reversal,順逆, fullness, and emptiness, and clinging rigidly, one is like facing East missing the West wall; partial observers cannot discuss transformation, time-bound observers cannot discuss greatness, leading to reinforcing Excess and draining Deficiency, harming patients. I cite classics to explain classics here to clarify major principles, not to limit Pathogenesis variations. Rules and compasses are craftsmen's tools; ingenuity lies in application. Wang Taipu (Wang Bing) understood this best; his annotations are exquisite yet overlooked. I admire him greatly and append them below. Wang said: Sage words are profound. Investigating presence/absence, addressing excess/deficiency covers all. For severe Cold unresponsive to heat therapy, it indicates Kidney-Fire deficiency; for intermittent Heat, it indicates Kidney-Water deficiency. Internal obstruction with vomiting prevents food intake, indicating Heart-Fire excess. Vomiting after eating indicates Heart-Fire deficiency. Sudden profuse diarrhea indicates Kidney-Water deficiency. Chronic loose stools indicate Kidney-Water deficiency. Heart excess generates Heat; Kidney excess generates Cold. Kidney deficiency causes internal Cold; Heart deficiency causes internal Heat. Heat unresponsive to cold indicates Water deficiency; Cold unresponsive to heat indicates Fire deficiency. Short-lived heat response indicates Heart deficiency; short-lived cold response indicates Kidney deficiency. Drain excess, tonify deficiency. Balance interior/exterior, unblock congestion, ensure smooth Qi and Blood flow, harmonizing Cold/Heat and Yin/Yang. If heat treatment with cold fails, or cold treatment with heat causes agitation, it is due to Qi stagnation. Water/Fire principles apply to all Qi. Thus, investigating presence/absence and addressing excess/deficiency to ensure smooth Qi flow is the subtle way. "Five Overcoming" refers to the mutual overcoming of Five Phases, using Cold/Hot/Warm/Cool/Damp and Sour/Sweet/Bitter/Pungent/Salty as governing laws.)