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Xu (Deficiency) and Shi (Excess) are the fundamental categories of disease. Bu (Tonification) and Xie (Drainage) are the laws of treatment. Predecessors have discussed this in detail. Here, I extract the key points, combined with notes from my daily reading, compile them here, as an aid to reviewing old knowledge.

The discussions on Xu and Shi in the *Huangdi Neijing* (Yellow Emperor's Inner Canon), *Nanjing* (Classic of Difficult Issues), and Zhang Zhongjing's works are very complex. Some distinguish Xu and Shi based on the decline or abundance of Zheng Qi (Upright Qi): "When the pulse comes rapidly and departs slowly, it is Exterior Excess and Interior Deficiency; when it comes slowly and departs rapidly, it is Exterior Deficiency and Interior Excess." Some distinguish based on the excess of Xie Qi (Pathogenic Qi) and the decline of Jing Qi (Essence Qi): "When Xie Qi is excessive, it is Excess; when Jing Qi is depleted, it is Deficiency." Some consider the diseased part as Excess and the healthy part as Deficiency: "Pain internally and comfort externally indicate Internal Excess and External Deficiency; pain externally and comfort internally indicate External Excess and Internal Deficiency." Some consider pathological manifestations as Deficiency and normal states as Excess: "Yang Excess and Yin Deficiency are cured by purgation but killed by diaphoresis; Yin Excess and Yang Deficiency are cured by diaphoresis but killed by purgation." Some consider diseases in the Qi level that are formless as Deficiency, and diseases in the Blood level that are有形 (form/material) as Excess; this distinguishes Baihu Tang (White Tiger Decoction) from Chengqi Tang (Order the Qi Decoction). Some consider mild conditions as Deficiency and severe ones as Excess; this distinguishes Daxianxiong Tang (Major Inhibiting Chest Decoction) from Xiaoxianxiong Tang (Minor Inhibiting Chest Decoction) and Xiexin Tang (Drain the Heart Decoction). Some consider dynamic conditions as Deficiency and static ones as Excess; accumulation in Zang organs is called Ji (Accumulation), and in Fu organs is called Ju (Gathering). Some consider chronic, entrenched diseases as Excess and new-onset diseases as Deficiency, meaning deep pathogen in long illness and shallow pathogen in new illness. Some consider Cold as Deficiency and Heat as Excess, following the principle that the Yang pathway is often Excess and the Yin pathway is often Deficiency. Some consider Cold as Yin Excess and Yang Deficiency, and Heat as Yang Excess and Yin Deficiency, following the principle of Yin-Yang opposition and categorization. Some consider Qi stagnating upward as Excess, sinking downward as Deficiency, internal knotting as Excess, and external scattering as Deficiency, describing these based on the accumulation, dispersion, emptiness, and firmness of pathological forms. As for pathogens coming from the Mother organ being Excess pathogens, and those coming from the Child organ being Deficiency pathogens, this is the great principle of the five elements' mother-child succession and reverse/forward flourishing/waning. The first chapter of the *Neijing* warns against Xu Xie (Deficiency Pathogens) together with Zei Feng (Thief Wind), stating that if pathogens leave but are not expelled, it is called Qi Yin (Qi Overflow), where one overcomes what one normally controls and insults what normally controls one. Later generations considering Xu Xie as self-healing without treatment is erroneous. This is a general overview of Xu and Shi.

Once Xu and Shi are distinguished, Bu and Xie can be applied. The *Lingshu·Zhongshi* (Spiritual Pivot: End and Beginning) states: "When Qi arrives and there is effect, drainage makes it more deficient; if the pulse is large as before but not firm, although feeling comfortable, the disease remains. Tonification makes it more substantial; if the pulse is large as before but becomes firmer, although feeling comfortable, the disease remains." Therefore, tonification leads to Substantiality, drainage leads to Deficiency; even if pain does not disappear immediately with the needle, the disease must recede. This is the mechanism of Bu and Xie.

Regarding the subtleties of Bu and Xie methods, none are more detailed than in the *Suwen* (Basic Questions) and the Treatise on Yin and Yang, which Bian Que (Yue Ren) and Zhang Zhongjing further elucidated. The *Zangqi Fashi Lun* (Treatise on Organ Qi Following Time) clarifies Bu and Xie based on the nature of what the Five Zang Organs dislike and desire. It says: "The Liver dislikes tension; urgently eat Sweet flavor to relax it. The Heart dislikes laxity; urgently eat Sour flavor to astringe it. The Spleen dislikes dampness; urgently eat Bitter flavor to dry it. The Lung dislikes rebellious Qi; urgently eat Bitter flavor to drain it. The Kidney dislikes dryness; urgently eat Pungent flavor to moisten it, open the interstices, deliver fluids, and circulate Qi. The Liver desires dispersion; urgently eat Pungent flavor to disperse it. Use Pungent to tonify the Liver, Sour to drain it. The Heart desires softening; urgently eat Salty flavor to soften it. Use Salty to tonify the Heart, Sweet to drain it. The Spleen desires relaxation; urgently eat Sweet flavor to relax it. Use Bitter to drain the Spleen, Sweet to tonify it. The Lung desires gathering; urgently eat Sour flavor to gather it. Use Sour to tonify the Lung, Pungent to drain it. The Kidney desires firmness; urgently eat Bitter flavor to firm it. Use Bitter to tonify the Kidney, Salty to drain it." The *Zhiyao Dalun* (Great Treatise on the Most Essential) clarifies Bu and Xie based on the victory and revenge of the Six Qi ruling the Heaven and Earth. The text is very detailed; here I list the treatment for the victorious Qi ruling the Heaven, attaching the rest. When Wind dominates due to the ruling Qi of Heaven, treat with Pungent-Cool, assist with Bitter-Sweet, use Sweet to relax, and Sour to drain. (When ruling the Earth, Wind dominates internally; treat with Pungent-Cool, assist with Bitter, use Sweet to relax, and Pungent to disperse. If Wind rules the Earth and Cold counter-vanquishes it, treat with Acid-Warm, assist with Bitter-Sweet, and Pungent to balance. If Wind transforms at Heaven and Cold counter-vanquishes it, treat with Acid-Warm, assist with Sweet-Bitter. Jueyin Victory: treat with Sweet-Clear, assist with Bitter-Pungent, drain with Sour. Jueyin Revenge: treat with Acid-Cold, assist with Sweet-Pungent, drain with Sour, relax with Sweet. Master of Wood position: drain with Sour, tonify with Pungent, first Sour then Pungent. Guest of Jueyin: tonify with Pungent, drain with Sour, relax with Sweet.) When Heat dominates, treat with Salty-Cold, assist with Bitter-Sweet, and Sour to gather. (Internal Heat: treat with Salty-Cold, assist with Sweet-Bitter, gather with Sour, emit with Bitter. Heat rules Earth, Cold counter-vanquishes: treat with Sweet-Hot, assist with Bitter-Pungent, balance with Salty. Heat transforms at Heaven, Cold counter-vanquishes: treat with Sweet-Warm, assist with Bitter-Acid-Pungent. Shaoyin Victory: treat with Pungent-Cold, assist with Bitter-Salty, drain with Sweet. Shaoyin Revenge: treat with Salty-Cold, assist with Bitter-Pungent, drain with Sweet, gather with Sour, emit with Bitter-Pungent, soften with Salty. Master of Fire position: drain with Sweet, tonify with Salty, first Sweet then Salty. Guest of Shaoyin: tonify with Salty, drain with Sweet, gather with Salty. Note: 'gather' should likely be 'soften', or 'Salty' should be 'Acid'.) When Dampness dominates, treat with Bitter-Hot, assist with Acid-Pungent, dry with Bitter, drain with Dan (Light/Bland). If Dampness is upper and hot, treat with Bitter-Warm, assist with Sweet-Pungent, stop when sweating occurs. (Internal Dampness: treat with Bitter-Hot, assist with Acid-Dan, dry with Bitter, drain with Dan. Dampness rules Earth, Heat counter-vanquishes: treat with Bitter-Cold, assist with Salty-Sweet, balance with Bitter. Dampness transforms at Heaven, Heat counter-vanquishes: treat with Bitter-Cold, assist with Bitter-Acid. Taiyin Victory: treat with Salty-Hot, assist with Pungent-Sweet, drain with Bitter. Taiyin Revenge: treat with Bitter-Hot, assist with Acid-Pungent, drain, dry, and vent with Bitter. Master of Upper position: drain with Bitter, tonify with Sweet, first Bitter then Sweet. Guest of Taiyin: tonify with Sweet, drain with Bitter, relax with Sweet.) When Fire dominates, treat with Salty-Cold, assist with Bitter-Sweet, gather with Sour, emit with Bitter, restore with Sour. (Internal Fire: treat with Salty-Cold, assist with Pungent-Sweet, gather with Sour, emit with Bitter. Fire rules Earth, Cold counter-vanquishes: treat with Sweet-Hot, assist with Pungent-Sweet, balance with Salty. Fire transforms at Heaven, Cold counter-vanquishes: treat with Sweet-Hot, assist with Pungent-Sweet. Shaoyang Victory: treat with Pungent-Cold, assist with Sweet-Salty, drain with Sweet. Shaoyang Revenge: treat with Salty-Cold, assist with Pungent-Sweet, soften with Salty, gather with Sour, emit with Bitter-Pungent, do not go far from Heat, do not violate Warm/Cool. Same as Shaoyin. Master of Fire position same as Shaoyin. Guest of Shaoyang: tonify with Salty, drain with Sweet, soften with Salty.) When Dryness dominates, treat with Bitter-Warm (New Correction: Wet should be Warm), assist with Acid-Pungent, drain downwards with Bitter. (Internal Dryness: treat with Bitter-Warm, assist with Sweet-Pungent [New Correction: Acid-Pungent], drain downwards with Bitter. Dryness rules Earth, Heat counter-vanquishes: treat with Pungent-Cold, assist with Bitter-Sweet, balance with Acid, harmonize for benefit. Dryness transforms at Heaven, Heat counter-vanquishes: treat with Pungent-Cold, assist with Bitter-Sweet. Yangming Victory: treat with Acid-Warm, assist with Pungent-Sweet, drain with Bitter. Yangming Revenge: treat with Pungent-Warm, assist with Bitter-Sweet, drain and vent with Bitter, tonify with Acid. Master of Metal position: drain with Pungent, tonify with Acid, first Pungent then Acid. Guest of Yangming: tonify with Acid, drain with Pungent, vent with Bitter.) When Cold dominates, treat with Pungent-Hot, assist with Sweet-Bitter, drain with Salty. (Internal Cold: treat with Sweet-Hot, assist with Bitter-Pungent, drain with Salty, moisten with Pungent, firm with Bitter. Cold rules Earth, Heat counter-vanquishes: treat with Salty-Cold, assist with Bitter-Pungent. Taiyang Victory: treat with Sweet-Hot [New Correction: Bitter-Hot], assist with Pungent-Acid, drain with Salty. Taiyang Revenge: treat with Salty-Hot, assist with Sweet-Pungent, firm with Bitter. Master of Water position: drain with Salty, tonify with Bitter, first Salty then Bitter. Guest of Taiyang: tonify with Bitter, drain with Salty, firm with Bitter, moisten with Pungent, open interstices, deliver fluids, circulate Qi.) Summarizing the main idea, it is merely controlling the Victorious Qi and pacifying the Revenge Qi. For example, if Wood wins, Metal is weak and fears nothing, thus overcoming Earth; so tonify Metal to control it, support Earth to oppose it. Since Victorious Qi cannot be directly broken, guide it with flavors that tonify Fire to open the path of nourishment for Wood, allowing its Qi to vent without stagnation; this is called Drainage, truly wonderful. But now Metal advances and Wood retreats, leaving Earth without fear, possibly overcoming Water next; so balance it by tonifying Water to nourish the Yuan Shen of Wood, preventing insult from counter-attack. This treats the Victorious Qi of the current season. If it is Counter-Vanquishing, it is a Deficiency Pathogen or Ghost Qi, not the proper seasonal Qi. That counter-vanquishing causes this to stagnate; stagnation erupts violently, requiring prevention. Revenge Qi is the eruption of Stagnation Qi. Once erupted, nothing remains. Treatment involves re-pacifying Revenge and Victory, examining pulse and symptoms to regulate. Thus: "When Victory arrives, the Reporting Qi is hidden and屈 (subdued) and not yet emitted; when Revenge arrives, names do not differ by Heaven/Earth, all follow Revenge Qi methods." Also: "Greatly revenging Victory leads to Main Victory, causing reverse disease." Also: "Must break Stagnation Qi, nourish its source, do not assist Victory, do not sponsor Revenge; this is Supreme Treatment."

The *Nanjing* states: "East is Excess, West is Deficient; Drain South, Tonify North." Old interpretations were confused and forced; actually, the meaning is straightforward and does not require deep speculation. East Excess and West Deficiency do not mean one must drain East and tonify West, but rather must drain South and tonify North. It means besides draining East, one may still drain South, but absolutely cannot tonify South; besides tonifying West, one may still tonify North, but absolutely cannot drain North. The following text deduces the mutual balancing of Five Elements and the principles that "Child can make Mother Excess" and "Mother can make Child Deficient," specifically elaborating on why one drains South and tonifies North. "Water defeats Fire" concludes the previous section; "Child makes Mother Excess" starts the next; this is a theoretical argument detached from Wood's Child/Mother, so it connects back via "thus drain South tonify North." Later scholars, failing to understand the literary technique of connection and separation, stuck to the literal Mother/Child words, finding it obstructed. Adding "Generally/Fan" before "Child makes Mother Excess" clears it up.

The first chapter of *Jingui Yaolue* discusses treating disease before it arises: "Superior doctors treat disease before it arises. Why? Seeing Liver disease, knowing Liver transmits to Spleen, one must first solidify the Spleen. If Spleen is prosperous in the four seasons and resists pathogens, do not tonify it. Average doctors do not understand transmission; seeing Liver disease, they do not solidify Spleen, only treating Liver. For Liver disease, tonify with Sour, assist with Scorched Bitter, supplement with Sweet herbs to regulate. Sour enters Liver, Scorched Bitter enters Heart, Sweet enters Spleen. Spleen can injure Kidney; if Kidney Qi is weak, Water does not flow; if Water does not flow, Heart Fire becomes abundant, injuring Lung; if Lung is injured, Metal Qi does not flow; if Metal Qi does not flow, Liver Qi becomes abundant, and Liver heals itself. This is the subtlety of treating Liver by tonifying Spleen. This method applies to Liver Deficiency, not Excess. The Classic says: Do not make Deficiency more Deficient or Excess more Excess; tonify insufficiency, reduce surplus. This is the meaning. Other organs follow this." Xu's commentary follows the text and retains the true essence, but fails to clarify "Xu and Shi," confusing later generations. You and Huang deleted the middle paragraph, saying: "Zang diseases, Excess transmits, Deficiency does not." This misunderstands Xu/Shi. Excess transmitting is common sense; Deficiency transmitting is subtle, unknown to average doctors. All mentions of Xu/Shi in classics should be deduced from Five Elements Qi transformation. Liver is Wood, warm ascending; Heart is Fire, hot dispersing; Spleen is Earth, heavy damp; Lung is Metal, clear肃 (descending); Kidney is Water, cold sinking. These are the intrinsic Qi of the Five Zang. Excess intrinsic Qi is Excess; insufficient intrinsic Qi is Deficiency. Both Xu and Shi cause disease; *Jingui*'s meaning here refers to Deficiency. If Liver loses warmth/ascending and becomes Cold/descending, it is Deficiency. Liver Cold transmits to Spleen; Liver does not lift, Spleen Cold sinks, leading to endless diarrhea and death. Tonifying with Sour, assisting with Scorched Bitter, supplementing with Sweet uses their warm nature, not Cold flavors. "Spleen injures Kidney... Water does not flow" means Cold Qi repels. "Lung injured... Metal Qi does not flow" means Clear Qi is suppressed. "Metal Qi does not flow... Liver Qi abundant" means Liver fulfills its warm/ascending nature. "Kidney and Lung" refer to Qi transformation, not physical structure/function. Kidney is Cold Qi within Liver; Lung is Clear Qi within Liver. "Metal/Water Qi does not flow" means Cold/Clear Qi in Liver cannot act freely. Liver has received Cold pathogen, lost its nature; do not just drain Liver, but tonify Liver's substance and warm Earth to nourish Qi! If Liver Heat, spasms/fainting occur, transmitting not just to Spleen but also Heart; this is Surplus/Excess Pathogen. Treat by directly draining the Palace, or draining Heart/Spleen; do not use Scorched Bitter to assist Heart/Solidify Spleen; hence "Excess does not use this." Old注释 read "Xu/Shi" vaguely, causing confusion. *Nanjing* says: "Coming from behind is Deficiency Pathogen, coming from front is Excess Pathogen." This is the gist of Xu/Shi. Behind Liver is Kidney; Kidney is Cold Water. Liver carries Cold Water momentum to insult Spleen; thus solidifying Spleen contains controlling Kidney to treat the root. Liver/Spleen become warm/moist and rising, clearing Cold pathogen retreats. This is "injuring Kidney/Lung," i.e., injuring Cold/Clear pathogen in Liver. Li Dongyuan said: Using Pungent-Sweet-Warm-Hot herbs to tonify assists Spring/Summer ascending Qi, which is draining Autumn/Winter storing Qi. *Neijing* says: Kidney receives Qi from Liver, transmits to Heart, dies at Spleen; Liver receives Qi from Heart, transmits to Spleen, dies at Lung; this is reverse Qi flow, speaking of Excess Pathogen transmission. Different matters, comparable meanings. Liver receiving Qi from Heart is "from front," Excess Pathogen; drain Heart/Liver, tonify Spleen/Lung. Kidney receiving Qi from Liver: drain Liver/Kidney, tonify Heart/Spleen. Do not tonify Liver with Sour for Liver disease. *Neijing* considers Sour as Draining, *Jingui* considers Sour as Tonifying; this is Body/Function difference, discussed by predecessors. For Liver Excess treatment, *Neijing* says: "Wind dominating internally, treat with Pungent-Cool." These are major laws of Bu/Xie.

Others: Sweating, Vomiting, Purging are all Drainage; Warming, Cooling, Harmonizing are all Tonification. There are Direct Tonification/Direct Drainage, e.g., Sijunzi Tang tonifies Qi, Siwu Tang tonifies Blood. There are Indirect Tonification/Indirect Drainage, e.g., Tonify Mother for Deficiency, Drain Child for Excess. There are Combined Tonification/Combined Drainage, e.g., Tiaowei Chengqi Tang, Renshen Baihu Tang. There is Drainage as Tonification/Tonification as Drainage, e.g., attacking food so Spleen strengthens naturally, assisting Earth so Water dissipates naturally. There are Alternating Attack/Tonification, taking two formulas morning/evening or alternating days. This is Compound Formula, using both Tonification and Drainage formulas. There is Simultaneous Tonification/Drainage, different from combined; equal weight of Tonification/Drainage power in one formula. This is hardest; must avoid pathogens to prevent hidden dangers. Qian Zhongyang said: "If Lung has pathogens and Deficiency prevents attack, tonify Spleen and attack Lung." Crucially, if disease is in Qi level and Deficiency cannot bear attack, tonify Blood and attack Qi; if in Blood level and Deficiency cannot bear attack, tonify Qi and attack Blood. Thus Tonification power does not clash with pathogens, avoiding tonifying the pathogen. Ye Tianshi said: "Long-term disease must treat Collaterals." He argued long-term disease impedes Qi/Blood flow, causing stasis in blood collaterals, prolonging disease; must unblock collaterals to eliminate disease. Xu Lingtai and Chen Xiuyuan mocked this; however, Liu Hejian emphasized opening Xu Fu (mysterious gates); Zhu Danxi used Yu (Stagnation) methods for long-term disease; Hua Borren added Blood-invigorating/Meridian-unblocking herbs to Tonification formulas for faster effect; Shi Zaizhi's formulas used Sanleng/Ezhu; Wang Qingren's formulas used Taoren/Honghua. Are these not treating Collaterals? And *Neijing*'s concepts of Ascending/Descending/Entering/Exiting, guarding Jing Suis, regulating Qi, removing accumulated decay—are these not this meaning? *Neijing* also says: "If cooling causes heat, seek Water; if heating causes cold, seek Fire; this is seeking the affiliation." Also: "Treating disease must seek the Root. Disease acquisition is Root, manifestations are Branch; First disease is Root, subsequent disease is Branch. There are Guest Qi and Same Qi. Mild cases treat simultaneously, severe cases treat exclusively." These are the great principles of combining Tonification and Drainage.

Bu and Xie are determined by Xu and Shi. Since the meaning of Bu/Xie is broad and variations of Xu/Shi are numerous, let us cite ancients' discussions on Xu/Shi. Hua Tuo's *Zhongzangjing* says: "Diseases include Zang Deficiency/Zang Excess, Fu Deficiency/Fu Excess, Upper Deficiency/Upper Excess, Lower Deficiency/Lower Excess; presentations vary, requiring deep consideration. Bowel sounds, gas movement, cold feet/hands, food not entering stomach, frequent vomiting, emaciated skin/hair, wrinkled muscles, deaf/blind eyes, broken voice, panting walk, scattered spirit—this is Five Zang Deficiency. Pulse: light pressure active, heavy pressure faint; check location to diagnose Zang. Also, heavy pressure Sun/Xiao/Ruo/Wei/Duan/Se/Ruan/Ru all indicate Zang Deficiency. Deficiency requires Tonification, standard treatment! Overeating, difficulty urinating/defecating, chest fullness, limb/joint pain, heavy body, dizziness, swollen lips/mouth, blocked throat, urgent bowel gas, insensible skin/flesh, sudden panting/fatigue, occasional chills/fever, sores/abscesses arising, mood swings, spontaneous weakness or hyperactivity, stagnant Qi, stagnant Blood—this is Zang Excess. Pulse: light/heavy pressure both strong indicates Excess. Also Chang/Fu/Shu/Ji/Hong/Jin/Xian/Da all indicate Excess. Check meridian to diagnose Zang. Headache red eyes, hot skin/cold bones, relaxed limbs, congested Qi/Blood, recurring erysipelas..."