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Yellow Emperor asked: Medical theories state that cold syndromes are treated with hot remedies, and heat syndromes are treated with cold remedies; this is a standard that cannot be abandoned. However, there are cases where treating a heat syndrome with cold medicine fails to resolve the fever, and treating a cold syndrome with hot medicine fails to resolve the chills. When both conditions persist and new diseases arise, how should they be treated? (The phrase "treating heat with cold but heat remains" means using cold herbs for a heat syndrome, yet the heat signs persist. The phrase "treating cold with hot but cold remains" means using hot herbs for a cold syndrome, yet the cold signs persist. Furthermore, when cold herbs are used to treat heat, the old heat may remain while new cold arises; when hot herbs are used to attack cold, the old cold may not be eliminated while new heat arises. These situations require detailed investigation.)

Qibo replied: For those whose heat persists despite being treated with cold, one should tonify Yin; for those whose cold persists despite being treated with hot, one should tonify Yang. This is what is meant by "seeking their affiliation" (identifying the root nature of the disease). (When heat persists after treatment with cold, it implies that bitter-cold herbs were used, yet the heat increased. This is not due to excess Fire, but rather deficiency of True Yin. When Yin is deficient, Yang becomes relatively excessive, generating heat. Therefore, one should nourish Yin, meaning one should not merely clear Fire, but instead tonify Yin to harmonize with Yang. Once Yin Qi recovers, the heat will subside naturally. When cold persists after treatment with hot, it implies that acrid-hot herbs were used, yet the cold worsened. This is not due to excess Cold, but rather deficiency of True Yang. When Yang is deficient, Yin becomes relatively excessive, generating cold. Therefore, one should tonify Yang, meaning one should not merely purge Cold, but instead warm the Fire within Water. Once Yang Qi recovers, the cold will dissipate naturally. Thus, Wang Bing noted: "Enrich the source of Fire to eliminate shadows of Yin; strengthen the master of Water to control the brightness of Yang." He also stated: The origins of the Zang-Fu organs have masters of cold, heat, warmth, and coolness. Treating the Heart does not necessarily require hot herbs; treating the Kidney does not necessarily require cold herbs. If one enriches Heart Yang, even cold herbs can circulate freely; if one strengthens Kidney Yin, even hot herbs can be effective. Thus, sometimes treating heat with hot remedies or cold with cold remedies yields perfect results. Who understands this intent? This is Wang Bing's insight. However, what is meant by "enriching" and "strengthening" refers to warming and nourishing Yang Qi, and filling True Yin. What is meant by "source" and "master" refers to "seeking their affiliation." Affiliation refers to the root; the roots of Water and Fire lie within the Gate of Vitality (Mingmen).)

Yellow Emperor said: Excellent. Why do taking cold medicines result in heat, and taking hot medicines result in cold?

Qibo said: This occurs because one treats only the Exuberant Qi (Wang Qi), leading to an opposite reaction. (This continues the previous discussion to detail why taking cold medicines causes heat and hot medicines cause cold. "Treating Exuberant Qi" means that diseases involve Yin and Yang, and Qi has states of decline and exuberance. Failing to distinguish between decline and exuberance leads to treatments that exacerbate the condition. For example, in cases of Yang exuberance and Yin deficiency, there is Yin deficiency with Fire exuberance. If the practitioner does not know to tonify Yin to balance Yang, but instead uses bitter-cold herbs exclusively to suppress Fire, they fail to realize that bitter-cold herbs are descending and draining, which consumes Yin. As Yin is consumed, Fire becomes more exuberant, so taking cold medicines results in more heat; this is because Yin deficiency is unsuitable for descending methods. Similarly, in cases of Yang deficiency and Yin exuberance, Qi weakness generates cold. If the practitioner does not know to tonify Yang to dispel Yin, but instead uses acrid-warm herbs exclusively to scatter Yin Cold, they fail to realize that acrid-warm herbs are dispersing and consuming, which damages Yang. As Yang is damaged, cold becomes more severe, so taking hot medicines results in more cold; this is because Yang deficiency is unsuitable for dispersing methods. There is no other reason; the illness reacts this way because treatment focused solely on the Exuberant Qi. Consider summer: although externally hot, latent Yin resides internally, often causing middle-jiao cold. Winter: although externally cold, latent Yang resides internally, often causing interior heat. If one ignores this and insists on using cold herbs in summer to treat Fire exuberance, or hot herbs in winter to treat Cold exuberance, one may encounter middle-cold blocking Yang (where cold herbs cause heat) or middle-heat blocking Yin (where hot herbs cause cold). These are all consequences of treating the Exuberant Qi, causing the illness to react oppositely. Spring and autumn follow the same principles.)

Yellow Emperor asked: What if the condition manifests oppositely without treating the Exuberant Qi?

Qibo said: You ask very thoroughly! It is because the affiliations of the Five Flavors were not considered. When the five flavors enter the Stomach, they each go to the Zang organ they prefer to affect. Sour flavor enters the Liver first, Bitter flavor enters the Heart first, Sweet flavor enters the Spleen first, Acrid flavor enters the Lung first, and Salty flavor enters the Kidney first. (This explains why illness does not resolve even when not targeting the Exuberant Qi: it is due to inappropriate application of the affinities of the five flavors. All five flavors first enter the Stomach, then distribute to their preferred Zang organs. "Preferred to affect" means each flavor has an affinity with specific Zang organs. As stated in the *Nine Needles Treatise*: If the disease is in the sinews, avoid sour foods; if in Qi, avoid acrid foods; if in bones, avoid salty foods; if in blood, avoid bitter foods; if in flesh, avoid sweet foods. Violating these constitutes "not attending to the affiliations of the five flavors.") Long-term consumption increases the Qi of the corresponding organ, which is the normal transformation of substances. However, if this increase persists for a long time, it becomes a cause of premature death. (Each of the five flavors has a specific affinity. If flavors are used excessively, Qi becomes pathologically biased. Prolonged use inevitably increases Qi, which is the normal transformation. However, prolonged increase of Qi leads to Zang bias; Zang bias leads to extreme imbalance, which is the cause of premature death. As stated in the *Treatise on the Connection of Life and Heaven*: Excessive sour flavor causes Liver Qi to overflow and Spleen Qi to fail; excessive salty flavor causes labor in the large bones, shortening of muscles, and suppression of Heart Qi. The earlier part of this chapter discussed cold and heat regarding pathogenesis; the latter part discusses five flavors regarding medicinal administration. Medicinal administration must carefully assess the truth of the pathogenesis. Errors rarely fail to cause harm.)