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Predecessors all held that: diseases of the rich and noble are suitable for tonification, while diseases of the poor and lowly are suitable for purgation. Before personally attending to clinical cases, I also often cited this saying as a rule, but only now do I realize it is incorrect.

The rich and noble live in comfort and consume rich foods; their Zang-Fu organs and meridians invariably have phlegm-fluids (Tan-Yan) firmly adhering and stagnating, causing Qi mechanism (Qi-Ji) to be blocked and unable to circulate freely. Therefore, when pathogenic factors (Xie-Qi) occupy these areas and cannot be expelled, it is not due to a deficiency of Zheng-Qi (Upright Qi), but rather due to the failure of Zheng-Qi to move. Treatment should heavily employ dispersing and attacking methods. Moreover, since their Qi and Blood are abundant, they can tolerate such aggressive treatments; this group precisely fits this description. If one were to add heavy tonification instead, it would only increase their stagnation.

The poor and lowly suffer from inadequate coarse food and insufficient warm clothing. They engage in strenuous labor throughout the four seasons, with sweat frequently escaping, leading to a deficiency of Ying-Blood (Nutritive Blood) and dispersion of Wei-Qi (Defensive Qi), resulting in withered meridians. When illness strikes, they initially endure it silently without ceasing work, seeking medical help only when the condition becomes critically severe. Thus, the reason their pathogenic factors remain is not because Zheng-Qi fails to move, but truly because Zheng-Qi is deficient. Treatment must assist Zheng-Qi; once Zheng-Qi is replenished, the smooth flow of Qi mechanism will naturally inspire the body to drive out pathogens, unlike the Qi stagnation seen in those living in luxury who require heavy dispersing and attacking therapies.

Whenever I diagnose the pulse of the poor engaged in physical labor, the disease pulse may be coarse, large, and rigid, or short, weak, and minute; its rising and falling is always powerless, and upon palpation, it always lacks Shen-Spirit (Vitality). It is extremely rare to encounter pulses resembling those of the rich—large, slippery, and knotted. Generally, diseases of the rich belong to Qi and Blood stagnation, while diseases of the poor belong to Qi and Blood insufficiency. The argument that bones and sinews differ in fragility versus strength applies only when one is free of disease!

When treating illnesses among the poor, I supplement with Ren-Shen (Ginseng Root), Bai-Zhu (Atractylodes Rhizome), Dang-Gui (Angelica Sinensis Root), and Di-Huang (Rehmannia Root). The efficacy is very rapid. There is no other reason than this: barren land is easy to irrigate, and slippery Qi is easy to nourish. The *Nei Jing* (Inner Canon) states: "When the form is bitter [hardworking] and the mind is happy, disease arises in the sinews; treat with warming compresses and guiding exercises." This warms and assists Qi to promote its movement. For those whose form is already bitter [hardworking], one must not again use opening and draining methods. "When the form is comfortable and the mind is happy, disease arises in the flesh; treat with needles and stones [acupuncture]. When the form is comfortable and the mind is bitter [stressed], disease arises in the vessels; treat with moxibustion and acupuncture." This implies that those whose form is comfortable have blood excess requiring drainage. However, scholars who endure hardship, with empty homes, striving for both the Way and sustenance through myriad efforts, cannot be discussed on the same level as those indulging in rich meats and grains. Therefore, when both form and mind are bitter [hardworking/stressed], disease arises from exhaustion; treat with sweet medicines, indicating that the exterior and interior, Ying and Wei are all deficient. Form that is bitter requires tonification; form that is comfortable requires purgation. Is this not clearly observable?