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(Continuing from the previous text) The disease manifests as vomiting, with food regurgitated after a long retention; this indicates a lack of Fire (Yang deficiency, inability to rot and ripen food). Sudden, rapid diarrhea where food is not digested before expulsion indicates the presence of Fire (excessive pathogenic heat forcing fluids into the intestines). Chronic loose stools that start and stop irregularly indicate a lack of Fire (Spleen and Kidney Yang deficiency, failure in transportation and transformation). Therefore, excessive Heart Qi generates Heat patterns, while excessive Kidney Qi generates Cold patterns; Kidney Qi deficiency causes Cold to move within the Middle Jiao, and Heart Qi deficiency causes Heat to be retained internally. Furthermore, if Heat patterns do not respond to Cold treatments, it is due to a lack of Water (Yin); if Cold patterns do not respond to Hot treatments, it is due to a lack of Fire (Yang). [Note: In this specific context following Yao Zhi'an's commentary logic, "Heat not responding to Cold" often refers to True Cold/False Heat where the root is Yang deficiency ("No Fire"), and "Cold not responding to Heat" refers to True Heat/False Cold where the root is Yin deficiency ("No Water").] Thus, if Cold cannot be resolved by Cold methods, blame the lack of Water (Yin); if Heat cannot be resolved by Heat methods, blame the lack of Fire (Yang). If Heat treatments are ineffective quickly, blame Heart Qi deficiency; if Cold treatments are ineffective quickly, blame Kidney Qi insufficiency. Excess conditions are treated with draining, deficiency conditions with tonifying; deficient states are tonified, excess states are drained. For conditions in between, unblock congestion and obstruction, ensuring free flow of Qi and blood above and below; then Cold and Heat will naturally harmonize, and Yin and Yang will become balanced. Therefore, in prescriptions, using Cold herbs to treat Heat may result in the inability to ingest water and food if the Cold is too harsh; using Hot herbs to attack Cold may cause confusion and restlessness if the Heat is exacerbated. This occurs because Qi is not unblocked, leading to stagnation and these adverse effects. Regarding Water and Fire, the Qi of the other elements can be inferred. Thus it is said: seek the reality in excess conditions, seek the deficiency in deficiency conditions, hold accountable for excess, hold accountable for deficiency, and allow Qi to flow smoothly; this is the subtlety of the Dao.

"Wu Sheng" (Five Overcoming/Controlling) refers to the mutual overcoming and succession of the Five Elements. First, use the Cold, Summer-heat, Warmth, Coolness, and Dampness of the Five Elements, along with the Sour, Salty, Sweet, Bitter, and Pungent flavors, taking their mutual overcoming as the method.

Commentary: Zhang Jingyue says: "'Excess' refers to solid conditions, 'Deficiency' refers to empty conditions. 'Seeking' means seeking the root of existence and non-existence. It is like searching for an object; one must find its location to retrieve it easily. For example, Taiyin's damp transformation applies to Taiyang; Taiyang's cold transformation applies to Shaoyin; Shaoyin's fire transformation applies to Yangming; Yangming's dry transformation applies to Jueyin; Jueyin's wind transformation applies to Taiyin. Any excessive influence upon oneself is one's own excess condition, which is the true pathogen; reverse influence upon others is one's own deficiency condition, which is the false pathogen. This reality and emptiness of the Six Qi are what is meant by existence and non-existence. However, although Heaven and Earth's luck is divided into Five Movements and Six Qi, the application of Yin and Yang lies only in Water and Fire. Thus, Yang excess leads to Yin pathology, and Yin excess leads to Yang pathology. Draining the excessive Qi holds it accountable for its excess; cultivating the declining Qi holds it accountable for its deficiency. If one does not understand the Dao of reversal, compliance, reality, and emptiness, one inevitably commits the errors of 'making the excess more excess and the deficiency more deficient,' leaving harm to people."

The Emperor said: Excellent! What is the use of the Yin and Yang of the Five Flavors? Qibo said: Pungent and Sweet flavors disperse and diffuse, belonging to Yang; Sour and Bitter flavors induce vomiting and purgation, belonging to Yin; Salty flavor induces vomiting and purgation, belonging to Yin; Bland flavor seeps and drains, belonging to Yang. These six flavors either astringe or disperse, either relax or accelerate, either dry or moisten, either soften hardness or harden softness. Act according to their respective benefits, regulate their Qi, and make them balanced. (Vomiting is called Yong; purgation is called Xie; seeping drainage refers to urination. It means fluid separates from the ileum, filters into the bladder, and is transformed by the Qi of the bladder into urine for excretion. Commentary: Pungent, Sweet, Sour, Bitter, and Salty are the Five Flavors. Beyond these five is the Bland flavor, which precedes the five flavors. Its Qi is light and clear, so it primarily causes seepage and drainage, eliminating the stagnation caused by the five flavors. Together they are six; separately, each has its specific benefit. Acting according to these benefits allows the pathogenic Qi to be regulated. Pungent and Sweet mainly disperse, and Bland mainly seeps/drains; both belong to Yang, which is easy to understand. Sour, Bitter, and Salty all belong to Yin, which is also easy to understand. But why do they all induce vomiting and purgation? Vomiting is expulsion upward; purgation is expulsion downward. Conditions desiring vomiting or purgation usually involve accumulation and stagnation in the interior. Sour flavor is astringent and belongs to Wood, so it gathers accumulated matter and forces it upward; Bitter flavor is Cold and clears Fire, so it drives accumulated matter downward; Salty flavor softens hardness and moistens dryness, so it expels phlegm accumulation from the chest and throat upward, and fecal matter from the intestines downward. Each has its benefit, depending on the practitioner.)

The Emperor said: What if the cure is not achieved by regulating Qi? How should one treat it? Which toxic herbs and which non-toxic herbs should be used first or last? I wish to hear the principle. (Diseases arise in four categories: 1. Initially formed internally due to Qi movement; 2. Formed externally without initial Qi movement; 3. Disease arises internally initially due to Qi movement; 4. Disease arises externally without initial Qi movement. Those formed internally due to Qi movement include accumulations, masses, tumors, goiters, tubercles, epilepsy, etc. Those formed externally include carbuncles, sores, ulcers, scabs, scabies, gangrene, hemorrhoids, convulsions, edema, red eyes, rashes, swelling, pain, itching, etc. Those arising internally without Qi movement include retained fluids, food stagnation, hunger/fullness labor damage, leftover food, cholera, grief/fear/surprise/joy, longing/worry/knotting, etc. Those arising externally include miasmas, demons, insect/snake venom, gu poison, flying corpses, ghost strikes, collisions, falls, Wind-Cold-Summerheat-Dampness, cuts, stabs, slashes, beats, etc. Of these four types, some heal by treating only the interior, some by treating both, some by treating only the exterior, some by treating both, some by treating interior then exterior, some by treating exterior then interior. Some require simultaneous use of toxic herbs to attack, some require non-toxic herbs to regulate and guide. In such cases, methods vary: heavy or light, slow or fast, astringent or dispersing, moistening or drying, softening or hardening. Practitioners have different views, each adhering to their own mind, preferring Red (Dan) over White (Su), hence the question. Commentary: Wang Bing's notes detail the categories of disease origin, but this is a general discussion of etiology, not an explanation of the classic text. "Not achieved by regulating Qi" implies that besides the eight methods of regulating Qi (astringing, dispersing, relaxing, accelerating, etc.), are there other treatment methods?)

Qibo said: Whether toxic or non-toxic, the choice depends on the disease being treated, formulated according to the size and severity of the condition. (Meaning: As long as it breaks up accumulations, cures diseases, resolves emergencies, and saves lives, it is a good prescription. It is not that using toxic herbs first is right and later is wrong, or that non-toxic is wrong and toxic is right. One must measure the lightness and heaviness of the illness to formulate it.)

The Emperor said: Please explain the formulation principles. Qibo said: One Sovereign herb and two Ministers form a Small Formula. One Sovereign, three Ministers, and five Assistants form a Medium Formula. One Sovereign, three Ministers, and nine Auxiliaries form a Large Formula. Treat Cold with Heat, treat Heat with Cold. For minor illnesses, use the Reverse Method (Zheng Zhi); for severe illnesses, use the Compliance Method (Fan Zhi). (Minor illnesses are like human fire; they ignite with grass and burn with wood, can be subdued by wetness or extinguished by water. Thus, one reverses their nature to subdue and attack them. Severe illnesses are like Dragon Fire; they flare up when wet and burn fiercely when meeting water. Not understanding their nature, using wetness or water to subdue them only makes the flames reach the sky until the fuel is exhausted. Those who understand their nature act against common sense, using fire to drive out fire, causing the burning to self-extinguish and flames to vanish. Reverse treatment means attacking Heat with Cold and Cold with Heat. Compliance treatment means attacking with Cold or Heat in accordance with their nature. Although complying with nature, it is not always identical, hence the text later says: Reverse is Standard Treatment, Compliance is Counter-Treatment. Follow less or follow more, observing the situation. Commentary: Zhang Jingyue says: "Minor illnesses, such as Yang disease causing Heat or Yin disease causing Cold, show true forms easily, so they are minor and can be treated by reversal (Standard Treatment). Severe illnesses, such as extreme Heat turning to Cold or extreme Cold turning to Heat, present false symptoms that are hard to distinguish, so they are severe and require compliance (Counter-Treatment)." ) Harden things by削 (scraping/reducing), remove guest pathogens, warm the fatigued, dissipate knots, attack stagnation, moisten dryness, relax urgency, gather dispersion, tonify loss, promote movement of idleness, calm fright, use emesis or catharsis for upper/lower blockages, massage, bathe, press,劫 (seize/detain), open, and vent. Adapt to the situation as the goal. (Commentary: Hardness refers to masses. Guest refers to external pathogens; removing means driving them out from the surface. Warming means nourishing with warmth. Fatigue consumes Qi; if Cold/Cool herbs are used, stagnation worsens, so warming is appropriate. Idleness refers to erratic movement; guiding it to move. Calming has two meanings: suppressing excess or stabilizing chaos. Upper/Lower refer to vomiting/purging. Massage moves stagnation. Bathing cleanses filth. Pressing searches for hidden pathogens. Seizing takes away strong momentum. Adapting to the situation means knowing the cause and acting appropriately.)

The Emperor said: What are Reverse and Compliance? Qibo said: Reverse is Standard Treatment (Zheng Zhi); Compliance is Counter-Treatment (Fan Zhi). Follow less or follow more, observing the situation. (Commentary: Zhang Jingyue says: "Using Cold to treat Heat, and Heat to treat Cold, reversing the disease, is Standard Treatment. Using Cold to treat Cold, and Heat to treat Heat, complying with the disease, is Counter-Treatment. 'Follow less' means one same and two different; 'follow more' means two same and one different. One must observe the severity to adjust. If full compliance is suitable, all should be the same. Treatment involves reverse/compliance because diseases have minor/severe stages, and signs have true/false aspects. Cold/Heat and Deficiency/Excess have true/false aspects. True conditions are treated with Standard Treatment (easy); False conditions are treated with Counter-Treatment (difficult). True Cold: pulse deep/thin/weak/slow, cold limbs, vomiting, abdominal pain, diarrhea, clear frequent urination. Even if feverish, the patient desires clothing (floating Heat outside, sinking Cold inside). True Heat: pulse rapid/forceful/sliding/big/solid, irritability, panting, loud voice, constipation, dark scanty urine, fever with desire to uncover, pain/heat/thirst. These are true diseases; True Cold needs warming, True Heat needs clearing—this is Standard Treatment. False Cold: Yang signs resembling Yin, extreme Fire resembling Water. Exterior is cold but interior is hot. Pulse rapid/forceful or deep/beating. Body cold but dislikes clothing? No, text says 'dislikes clothing' for True Heat. For False Cold: 'Body cold but dislikes clothing' is incorrect in my summary, let's stick to text: 'Body cold but dislikes clothing' is actually a sign of True Heat (wanting to uncover). Wait, text says for False Cold: 'External cold but internal heat... pulse rapid forceful... body cold but dislikes clothing'? No, text says for False Cold: 'External cold... internal heat... pulse rapid forceful... body cold but dislikes clothing' is contradictory. Let's re-read carefully: 'True Heat... fever lifts clothes...'. 'False Cold... External cold but internal heat... pulse rapid forceful... body cold but dislikes clothing' -> This part of the source text provided seems to have a typo or I am misreading. Let's look at the source: '假寒者... 外虽寒而内则热... 或身寒恶衣'. Yes, 'shen han e yi' (body cold but hates clothing) is a sign of False Cold (True Heat). 'False Heat... External heat but internal cold... pulse weak... body hot but spirit quiet... speech delirious but voice faint... likes cold water but drinks little... tongue red but keeps covers on...'. This is False Heat (True Cold). Commentary continues: False Cold needs clearing internal Heat; False Heat needs warming True Yang. This is Counter-Treatment. Also, Excess/Deficiency: Excess drain, Deficiency tonify. But 'Extreme Deficiency has Excess symptoms' (False Excess); 'Extreme Excess has Deficient symptoms' (False Deficiency). True Deficiency: pale face, tired form, weak spirit, spontaneous sweating, incontinence, seminal emission, vomiting/blockage, chronic illness with many attacks, shortness of breath, overwork, shock. Though signs seem Excess, if pulse is weak/no spirit, it is Deficiency needing tonification. True Excess: pathogen blocking meridians/organs, Qi stagnation, Blood stasis. Pulse and signs both strong, needs attacking. Differentiating True/False is crucial. 'Excess is Pathogen strong, Deficiency is Essence lost.' If Zheng is depleted and Xie is strong, should we tonify Zheng or attack Xie? If Zheng is weak, even if Xie is strong, do not attack, lest Zheng collapse. Tonify Zheng first. Tonifying Yin attacks Heat; Tonifying Yang attacks Cold. If necessary, balance urgency, 'fight within defense'. This is treating Deficiency. If Zheng is intact, even slight Xie should not be tonified, lest it feed the pathogen. Attack Xie directly. This is treating Excess. Only those who can withstand attack are Excess. False Deficiency is rare; False Excess is common. False Cold is easy to treat; False Heat is easily mistaken. Excess is mostly Heat, Deficiency is mostly Cold. Zhu Danxi: 'Qi excess is Fire, so Excess can bear Cold.' My addition: 'Qi deficiency is Cold, so Deficiency can bear Heat.' Those who don't know True/False roots are not true doctors. Zhang Jingyue's theory is clear and comprehensive, supplementing the classics greatly.)

The Emperor said: What is Counter-Treatment? Qibo said: Treat Heat with Cold usage (Re-yin Han-yong), treat Cold with Heat usage (Han-yin Re-yong), treat Obstruction with Obstruction (Se-yin Se-yong), treat Diarrhea with Unblocking (Tong-yin Tong-yong). Subdue the main factor and address the cause first. Initially they appear similar, finally they differ. They can break accumulations, dissolve hardness, harmonize Qi, and ensure cure. (Commentary: Zhang Jingyue explains: 'Heat with Cold usage': For severe internal Cold, use Hot herbs. But Cold rejects Hot, so take Hot herbs and take them Cold. Once swallowed, the cold temperature disappears, and the Hot nature activates. This is compliant in feeling but effective in nature. 'Cold with Heat usage': For severe internal Heat, use Cold herbs. But Cold is rejected, so take Cold herbs and take them Hot. Once in the belly, the hot temperature dissipates, and the Cold nature acts. 'Obstruction with Obstruction': Lower Qi deficiency with Middle Jiao fullness. Dispersing fullness worsens lower deficiency; tonifying lower worsens middle fullness. Instead, strongly tonify the lower to unblock the middle. Lower becomes solid, middle fullness removes itself. 'Unblocking with Unblocking': Internal Heat or Cold causing stagnation and diarrhea. Use Hot purgatives for Cold stagnation, Cold purgatives for Heat stagnation. All four methods require subduing the root and seeking the cause. Starting similarly, ending differently. This is Counter-Treatment.)

The Emperor said: Excellent! What about curing through regulating Qi? Qibo said: Reverse or comply, reverse then comply, comply then reverse. Unblock Qi to make it harmonious; this is the Dao. (Commentary: Zhang Jingyue: 'Regulating Qi' means Qi was originally harmonious but accidentally affected by disease (weather/unexpected factors). Treatment still follows reverse/compliance to disperse pathogen and restore harmony.)

The Emperor said: Excellent! What about diseases moving from interior to exterior or vice versa? Qibo said: From Interior to Exterior, regulate the Interior. From Exterior to Interior, treat the Exterior. (Cut off the source.) From Interior to Exterior with severe Exterior symptoms, treat Interior first, then Exterior. From Exterior to Interior with severe Interior symptoms, treat Exterior first, then Interior. (Remove the root, then trim the branches.) If Interior and Exterior do not affect each other, treat the primary disease. (Commentary: 'Do not affect each other' means independent diseases. 'Seek the Root' means finding the origin. Treat root before branch.)

The Emperor said: The classics say treat Cold with Heat, treat Heat with Cold. Why do practitioners fail to follow this rule? If a Heat patient treated with Cold remains hot, and a Cold patient treated with Heat remains cold, and new diseases arise, how to treat? (Commentary: This asks about treatment error, confusing Standard with Counter-treatment.)

Qibo said: For all cases where Cold treatment fails to resolve Heat, seek the Yin. For all cases where Heat treatment fails to resolve Cold, seek the Yang. This is called seeking the affiliation/root. (Meaning: Boost the source of Fire to eliminate Yin shadow; strengthen the master of Water to control Yang sunlight. Crude physicians are shallow; they use Heat to attack Cold and Cold to treat Heat, creating new problems. They don't understand the source of organs. To treat Heart, one need not strictly use Heat; to treat Kidney, one need not strictly use Cold. Boost Heart Yang, and Cold will pass; strengthen Kidney Yin, and Heat will recede. Thus, sometimes treating Heat with Heat, and Cold with Cold, ensures success. Alas, are deaths caused by ignorant practitioners? Commentary: 'Boost Fire source...' is the essence of treatment. Zhang Jingyue: 'Cold treating Heat failing means bitter-Cold didn't work; not Fire excess, but True Yin deficiency. Tonify Yin to match Yang. Heat treating Cold failing means pungent-Hot didn't work; not Cold excess, but True Yang deficiency. Tonify Yang (Fire in Water). Zhang Jingyue's note is clear. Yin shadow stems from lack of Fire (Right Kidney). Yang sunlight starts from lack of...' [Text ends]