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(Su Wen, Chapter 74: Zhizhen Yao Dalun)

The Yellow Emperor asked: Qi (vital energy) has degrees of abundance and deficiency; diseases have excess and decline; treatments have urgency and slackness; prescriptions have large and small sizes. I wish to hear the general principles regarding these matters. (The Five Movements and Six Qi each have excess and deficiency, hence it is said that "Qi has abundance and deficiency." Human diseases inevitably fluctuate in excess or decline according to the Qi, therefore the urgency of treatment and the size of prescriptions must also follow specific rules based on the severity of the condition.)

Biqi replied: Qi has high and low positions; diseases are near or far; symptoms are interior or exterior; treatments vary in intensity. The key lies in ensuring the medicinal force reaches the precise location of the disease. (With Si Tian and Zai Quan governing the year, Qi has high and low levels; with meridians and Zang-Fu organs having upper and lower positions, diseases are near or far. Located deep inside is called "Interior" (Zhong); located on the surface is called "Exterior" (Wai). For mild conditions, treatment should be light; for urgent conditions, treatment should be heavy. "Ensuring it reaches where it is needed" means that one must ensure the medicinal force arrives at the site of the pathology and diligently seek the underlying cause.)

The Da Yao states: One Sovereign herb and two Minister herbs constitute a Odd prescription; Two Sovereign herbs and four Minister herbs constitute an Even prescription; Two Sovereign herbs and three Minister herbs constitute an Odd prescription; Three Sovereign herbs and six Minister herbs constitute an Even prescription. (Note: "Three Sovereign" should likely be "Two Sovereign," indicating a textual error. The Da Yao refers to ancient methods. The herb that primarily treats the disease is the Sovereign (Jun), which should be used in double dosage. Herbs that assist the Sovereign are Ministers (Chen). Odd numbers belong to Yang, referring to ancient single-formula prescriptions. Even numbers belong to Yin, referring to ancient compound prescriptions. Thus, one Sovereign and two Ministers total three; two Sovereigns and three Ministers total five; both are Odd prescriptions. Two Sovereigns and four Ministers total six; two Sovereigns and six Ministers total eight; both are Even prescriptions. Odd prescriptions belong to Yang and are light; Even prescriptions belong to Yin and are heavy.)

Therefore, it is said: For near diseases, use Odd prescriptions; for far diseases, use Even prescriptions. Diaphoretic (sweating) therapies do not use Even prescriptions; purgative therapies do not use Odd prescriptions. (Near diseases are upper and Yang, so Odd prescriptions are used for their light and slow action. Far diseases are lower and Yin, so Even prescriptions are used for their heavy and rapid action. Sweating therapies avoid Even prescriptions because Yin nature is sinking and cannot reach the exterior. Purgative therapies avoid Odd prescriptions because Yang nature is ascending and cannot descend downward. Old editions stated "Sweating does not use Odd, Purging does not use Even," but Wang Bing's commentary noted "Diaphoretics do not use Even formulas, Cathartics do not use Odd systems," which contradicts the text. However, Wang's annotation aligns with medical logic, while the original text seems erroneous; thus, we correct it to follow Wang. Note: This section specifically uses Odd/Even and Yin/Yang to categorize sweating and purging generally. The yin-yang nature of flavors and odors is certainly not secondary to Odd/Even counts. Hence, the following text elaborates further. The subtle intent here goes beyond mere numerical oddity/evenness, aiming to elucidate the meaning of prescription formulation. Students should deeply comprehend this through such insights. 'Odd' is pronounced like 'Ji'.)

Tonifying the upper and treating upper diseases requires slow-acting formulations; tonifying the lower and treating lower diseases requires rapid-acting formulations. Rapid action implies strong flavor and odor; slow action implies weak flavor and odor. Ensuring the medicinal force reaches its target is what this refers to. (To treat the upper, formulations should be slow-acting to allow retention and distribution in the upper body. To treat the lower, formulations should be rapid-acting to reach the Lower Jiao directly. Therefore, rapid action requires strong flavors and odors, while slow action requires weak ones. If a slow-acting formula has strong flavors, it will be harsh and leave quickly; if a rapid-acting formula has weak flavors, it will be gentle and fail to advance. Only when slowness/rapidity and strength/weakness are appropriately balanced can the medicinal force reach the disease site and capture the essence of treatment.)

When the disease site is distant, and the medicine's qi/flavor might be absorbed or blocked by the stomach midway, one can regulate administration via food intake without violating dosage protocols. (This means that if the disease is deep, but the medicine must pass through the stomach, improper administration may cause the medicine to be absorbed or blocked mid-way before reaching the disease. Therefore, food should be used as a regulator to ensure the medicine reaches both near and far sites—this is "passing through." If one wishes the medicine to reach far sites, take it before meals; food will propel the medicine outward. If one wishes the medicine to stay near, take it after meals; food will block the medicine, keeping it localized. By analogy, the speed of ingestion, the rising/falling properties of root vs. tip, and the suitability of decoctions, pastes, pills, and powders all have appropriate methods. Thus, one should not violate these protocols.)

Therefore, the principle of balancing Qi is: For near diseases, whether using Odd or Even prescriptions, reduce the dosage. For far diseases, whether using Odd or Even prescriptions, increase the dosage. Large dosages contain fewer ingredients; small dosages contain more ingredients. More ingredients go up to nine; fewer ingredients go down to two. (Balancing Qi means correcting imbalance. Upper locations are near; lower locations are far. Both near and far have Yin-Yang and Interior-Exterior distinctions, so far and near prescriptions both employ combinations of Odd and Even methods. For example, an Odd prescription divided into two parts, or an Even prescription divided into two Odd parts, represents mutual utility. Thus, for near diseases using Odd/Even, reduce the dose. Small doses mean many ingredients, up to nine. Many ingredients mean lighter individual weights, resulting in weaker potency that only reaches nearby areas. For far diseases using Odd/Even, increase the dose. Large doses mean few ingredients, down to two. Few ingredients mean heavier individual weights, resulting in focused potency that reaches deep distances. These are methods combining Odd and Even. If a near disease is treated with a large dose, the medicine overwhelms the disease, termed "punishing the innocent." If a far disease is treated with a small dose, the medicine fails to reach the disease, like horses and cattle going in opposite directions. The previous text said "Near uses Odd, Far uses Even," describing standard laws. This text says "Near uses Odd/Even, Far uses Odd/Even," describing variable application. Knowing both variation and constancy allows one to respond to changes without fixed patterns.)

If an Odd prescription fails, switch to an Even prescription; this is called a Heavy Prescription (Chong Fang). If an Even prescription fails, use counter-assistance (Fan Zuo) to achieve the cure, employing Cold, Heat, Warm, and Cool properties to follow the nature of the disease. (This demonstrates round, flexible adaptation. Initially, if an Odd prescription is used but the disease persists, there must be a mismatch; one should then switch to an Even prescription. Alternating Odd and Even is called Chong Fang, i.e., Compound Prescriptions in later times. If an Even prescription also fails, one must investigate the subtlety, extremity, true/false nature of the disease and use counter-assistance. Counter-assistance means using drugs that share the nature of the pathogen to comply with its tendency. For example, treating Cold with Heat, but if Cold rejects Heat, add a small amount of Cold drug to facilitate entry. Treating Heat with Cold, but if Heat rejects Cold, add a small amount of Heat drug to facilitate entry. Similarly, taking Cold drugs hot, borrowing heat to move cold; taking Heat drugs cold, borrowing cold to move heat. These are the subtle applications of counter-assistance and variation, aiming to guide the disease's momentum. Wang Bing said: Heat opposes Cold, and Cold opposes Heat. Tiny amounts of Heat are subdued by massive Cold; tiny amounts of Cold are dissolved by massive Heat. However, extreme Cold or Heat will contend with opposing natures and resist different energies. Just as different sounds do not resonate and different energies do not combine, the disease will fear attack and refuse to engage. If attacked, the disease energy and drug energy will balance each other, forming self-generated Cold/Heat closures and defenses. Therefore, the Sage uses counter-assistants to harmonize the energy, making sound and energy correspond, mixing Cold and Heat, so that they start similarly but end differently. They penetrate and rot the hardness, break rigidity, and dissolve fragility.)