Library

Contemporary physicians are often biased by their own preconceptions; some prefer to use hot-natured medicines, while others prefer cold-natured medicines. However, the *Suwen* (Plain Questions) contains the chapter "Yi Fa Fang Yi Lun" (Discussion on Different Methods and Appropriate Locations), which indicates that there was never such bias in ancient times. Ancient excellent physicians would always assess the patient's deficiency or excess (*Xu Shi*) and observe the Yin or Yang nature of the disease before administering decoctions. Whether tonifying or purging, treatment was tailored to the specific syndrome. For instance, if bleeding resulted from Yang deficiency, *Gan Jiang* (Dried Ginger) and *Fu Zi* (Prepared Aconite Root) were used; for various deficiencies and damages, *Ren Shen* (Ginseng Root) and *Huang Qi* (Astragalus Root) were employed to tonify; for coughs caused by phlegm-heat obstruction, *Huang Qin* (Scutellaria Root) and *Lian Zi* (Lotus Plumule) were used to clear heat; for constipation with heat accumulation, *Xiao Shi* (Mirabilite) and *Da Huang* (Rhubarb Root and Rhizome) were used to purge heat and promote bowel movement. Were these methods entirely abandoned? Xu Shuwei once stated: "Even infants with cold pathogens in the body can take *Jin Ye Dan* (Golden Liquid Pill); even the elderly and frail with heat toxins in the viscera can take *Da Huang*." This truly exemplifies the profound principle of adapting treatment to changing circumstances.

Diseases are treated by either direct regulation (*Zheng Zhi*) or contrary regulation (*Fan Zhi*). While everyone knows the method of direct regulation, contrary regulation involves following the apparent manifestation of the pathogenic qi. For example, when treating heat syndromes, one should not use only cold-natured medicines but must assist them with acrid-warm medicines as guides; when treating cold syndromes, one should not use only warm-natured medicines but must assist them with acrid-cool medicines as guides. Otherwise, the disease will reject the medicine, leading to rejection and non-entry of the drug, causing the condition to worsen. If the condition worsens, pain will become even more severe. Zhu Danxi treated hernia by using *Zhi Zi* (Gardenia Fruit) to remove damp-heat, assisted by *Wu Tou* (Aconite Root) to disperse cold stagnation. Ancient formulas using honey-fried *Fu Zi* combined with *Cong Bai San* (Green Onion White Powder) plus *Da Huang*, etc., reflect the meaning of the *Neijing* (Inner Canon): "When using cold, avoid cold [pathogens/seasons]; when using heat, avoid heat."

I once heard an old physician say that treating diseases in the North should prioritize attacking external pathogens, whereas treating diseases in the South should focus on preserving internal Qi. Generally, the wind and qi in the North are dense, people have robust constitutions, consume twice as much food as usual, live simply, and rarely suffer damage to their Yuan Qi. When illness occurs, bitter-cold and draining medicines are used, making the patient feel as if a burden has been lifted, bringing relief and clarity. In contrast, people in the Southeast have fragile constitutions, loose interstices (*Cou Li*), and indulge excessively in diet and sexual desires, which is vastly different from those in the Northwest. To indiscriminately attack them with bitter-cold agents would be akin to killing someone with a blade. Expanding upon his words, I argue: Northerners have solid and dense Qi, yet does this mean everyone presents with excess patterns? Southerners have thin Qi, yet does this mean everyone presents with deficiency patterns? Practitioners must apply flexible judgment, treating according to the patient's deficiency or excess, thereby avoiding the弊端 of bias.

Zhou Boqi (Ding) from Jiahe stated that there are three difficulties in treating patients of high status: First, many physicians compete to display their skills, mixing attacking and tonifying methods indiscriminately. Second, they encounter individuals who do not treat themselves with dignity or respect others, associating only with those they deem unworthy. Third, they yield to flattery and cannot completely forbid the patient's desires. I also have three difficulties to supplement Zhou's incomplete points: Fourth, prescribing medication on the same day as onset, seeking immediate effects. Fifth, browsing medical texts and self-treating illnesses. Sixth, distrusting herbal medicine and relying solely on ghosts and gods.