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The method of reducing pathogenic factors is like when pathogenic heat enters the stomach; one uses a salty and cold formula to attack and eliminate it. For example, if there is central deficiency leading to abdominal distension with severe internal damp-heat, and the person has strong qi and substantial constitution, then one attacks and purges it. Or if the pathogenic factor is too vigorous to be removed all at once, one uses a method to seize and reduce its momentum so that it declines. For instance, dysentery caused by damp-heat cannot be treated with mild formulas; one may use attacking or seizing methods to eliminate the pathogen. These are all methods of "reduction" (Duo).

Metal depression (Lung Qi stagnation) is treated with dispersion ("Xie"). "Dispersion" refers to promoting diuresis and benefiting urination to unblock the Qi mechanism. For example, the Lung Metal is the source of Kidney Water. If Lung Metal is scorched by Fire, its regulatory function fails, causing stagnation at the source and closure of the fluid pathways. One should regulate the Metal transformation and nourish the source to benefit the flow. Again, if Lung Qi is full and breathing is labored, only a formula that benefits Lung Qi can sufficiently unblock it. These are all methods of "dispersion". Wang Bing said: "Promote diuresis, release the exterior, benefit urination." Promoting diuresis and benefiting urination certainly belong to dispersing Metal depression, but what about the term "release the exterior"? Is it because the skin and hair belong to the Lung, and when affected by pathogens it constitutes Metal depression, so releasing the exterior is a form of dispersion? I argue that if this were the case, then any tendon disease would be Wood depression, and any flesh disease would be Earth depression. The term "release the exterior" is inappropriate here and should be omitted. Temporarily placing "release the exterior" among "promote diuresis and benefit urination" would result in three treatments. Therefore, I change it to "promote diuresis and benefit urination".

Water depression is treated with restraint ("Zhe"). "Restraint" means controlling, suppressing, attacking, and defeating it, gradually killing its excess. For example, in edema diseases, water qi overflows and blocks the fluid pathways. What water cannot overcome is Earth. Now, if Earth qi is weak and cannot control water, it suffers from water's insult. Treatment should strengthen Spleen Earth and support its transportation and transformation, enabling it to control water so it dares not invade, after which the fluid pathways open and recovery occurs. Or if the disease momentum is already vigorous and the above methods cannot immediately control it, one uses water-draining formulas to attack and defeat it; or employs the three methods of "removing accumulated stasis", "opening the ghost gate" (sweating), and "cleaning the fu organs" (diuresis), alternating them to gradually calm the condition. Wang Bing's statement "suppress it to control its rushing rebellion" precisely aims to curb its flooding momentum. Strengthening Earth is defense (Shou); draining water is attack (Gong); combining the three methods is a comprehensive strategy to win decisively. Defense, attack, and comprehensive strategies are all methods for treating water disorders. However, if one does not carefully examine the deficiency/excess, chronicity, and depth of the disease and applies treatment recklessly, few will avoid collapse or death.

Although there are fixed methods for treating the five depressions, prolonged pathogenic invasion inevitably damages righteous qi. Even if the pathogen is gone, how can righteous qi recover immediately? If one does not harmonize the righteous qi to restore its proper position and normal state, the subtlety of treatment is not fully exhausted even after treating the depression. Hence it says: "Harmonize the Qi." If harmonizing the Qi still leaves it excessive and unrested, one should tonify its unconquered element to restrain it. For example, if Wood is excessive, one should tonify Metal, as Metal controls Wood, thus calming Wood. The unconquered element is that which is feared. Hence it says: "Excess is restrained by what it fears." That which controls things is what things desire; that which is controlled by things is what things do not desire. Following desires brings joy; opposing desires brings aversion. Now, using what is dreaded to control implies "draining" (Xie). Wang Bing stated that salty flavor drains the Kidney and sour flavor drains the Liver, but he did not fully grasp the essence. Nevertheless, from "harmonizing the Qi" onwards seems to be the original intent of the Classic, so I deduce its meaning as such. If expanded for flexible application, it need not be rigidly adhered to.

The Yellow Emperor asked: What about false conditions? The Yellow Emperor asked: What about false conditions? Qibo answered: When there is a false appearance, there are no prohibitions. (False appearance refers to righteous qi being deficient and pathogenic qi being dominant, so one borrows cold, hot, warm, or cool properties to supplement the righteous qi, meaning the dominant pathogen can be attacked.) Wang Bing's commentary: Borrowing cold, hot, warm, or cool to supplement righteous qi allows treating heat with heat, cold with cold, etc. This refers to main qi being deficient and guest qi being dominant. (Guest qi refers to the six climatic influences succeeding each other; main qi refers to the five zang organs corresponding to the four seasons' peak times.)

Medicinal flavors have density and thinness; their natures have agitation and tranquility; their therapeutic preservation has more and less; their power and transformation have depth and shallowness. (I interpret this as referring to the medicinal flavors and functions.) External pathogens invading from above downwards are balanced by the conquering element; external pathogens invading from outside inwards are treated by the conquering element. (Continued: Yin refers to movement into the unconquered territory. Invading from above downwards is heavenly qi; invading from outside inwards is earthly qi. Balance and treat according to the conquering element. Conquering refers to the five flavors and four temperatures, used according to the prevailing pathogen, as detailed below. E.g., for Wind excess under Heaven's influence, balance with pungent-cool, assist with bitter-sweet, soothe with sweet, drain with sour. For Wind excess under Earth's influence, treat with pungent-cool, assist with bitter, soothe with sweet, disperse with pungent. Wang Bing notes: Wind likes warmth and dislikes coolness, so cooling treats it by overcoming it. Bitter assists according to benefit. Wood hates urgency, so sweet soothes it; if suppressing, pungent disperses it. New corrections note: Heavenly influence governs the year; although there is excess, one should only balance, hence "balance" is used instead of "treat". Thus, Earth's influence uses "treat", Heaven's uses "balance".)

Carefully observe the location of Yin and Yang and harmonize them, aiming for balance. Correct treatment (Zheng Zhi) addresses the true nature of the disease (e.g., Yin disease without Yang involvement, treating heat with cold). Reverse treatment (Fan Zhi) addresses false symptoms (e.g., Yang location showing Yin pulse, treating cold with cold).

For mild pathogenic excess, follow it; for severe excess, control it. For pathogenic rebound, if mild, balance it; if violent, reduce it. All follow the prevailing pathogen, pacify the suppressed aspect, regardless of number, aiming for balance. This is the Way. High aspects are suppressed; low aspects are lifted; excess is reduced; deficiency is tonified. Assist with what is beneficial, harmonize with what is appropriate. Must stabilize the host and guest Qi, adapt to cold and heat. Similar conditions are treated oppositely (Ni); different conditions are treated similarly (Cong).

The Yellow Emperor asked: Qi varies in quantity, diseases vary in severity, treatments vary in speed, and formulas vary in size. I wish to hear the principles. Qibo answered: Qi has high and low positions; diseases have distant and near locations; symptoms have internal and external sites; treatments have heavy and light applications. Adapt to the target site. Generally: Jun 1, Chen 2 is an Odd (Qi) system; Jun 2, Chen 4 is an Even (Ou) system; Jun 2, Chen 3 is an Odd system; Jun 3, Chen 6 is an Even system. (Odd formulas historically refer to single herbs or combinations summing to odd numbers, suitable for upper/near diseases. Even formulas refer to combinations summing to even numbers, suitable for lower/far diseases.) Thus: Near diseases use Odd formulas; far diseases use Even formulas. Sweating does not use Odd formulas exclusively; purging does not use Even formulas exclusively. (Wang Bing notes: Sweating requires combination to generate enough Qi to reach the exterior; purging requires single action to avoid toxicity. Zhang Zhongjing's Guizhi Tang has 3 ingredients (Odd) for sweating; Dachengqi Tang has 4 ingredients (Even) for purging, showing flexibility based on timing.)

Tonifying upper/upper treatments use slow formulas; tonifying lower/lower treatments use rapid formulas. Rapid formulas have dense flavors; slow formulas have thin flavors, reaching the target appropriately. If the disease is far, use larger doses; if near, use smaller doses. Large formulas have fewer doses; small formulas have more doses (up to 9 or down to 2). If Odd formulas fail, use Even formulas (Chong Fang). If Even formulas fail, use reverse assistance (Fan Zuo), matching the disease's nature (cold/hot/warm/cool) to allow entry.

The Yellow Emperor asked: How are the five flavors used? Qibo answered: Pungent and sweet disperse and are Yang; sour and bitter induce vomiting/purging and are Yin; salty induces vomiting/drainage and is Yin; bland promotes diuresis and is Yang. These six actions (astringing, dispersing, slowing, urgent, drying, moistening, softening, hardening) are applied according to benefit to harmonize Qi and achieve balance.

The Yellow Emperor asked: For conditions not arising from Qi disturbance, how to treat? Which toxic/non-toxic herbs to use first? Qibo answered: Toxicity depends on the disease treated, sized appropriately. Heat is treated with cold; cold with heat. Mild cases oppose the nature (Ni); severe cases follow the nature (Cong). Hardness is削 (scraped/reduced); guests are removed; labor is warmed; knots are scattered; retention is attacked; dryness is moistened; urgency is slowed; scattering is gathered; deficiency is benefited; inactivity is moved; shock is calmed. Upper/lower, rubbing/bathing, pressing/seizing, opening/dispersing—adapt to the situation.

Reverse (Ni) is correct treatment; Cong is reverse treatment. Observe the case to determine degree. Reverse treatment includes: Heat used with cold administration; Cold used with heat administration; Blockage treated with blockage (for deficiency blockage); Flow treated with flow (for excess flow). Conceal the main cause and address the root. Initially similar, finally different. Can break accumulations, dissolve hardness, harmonize Qi, ensure cure. (Examples provided for heat/cold reversal techniques.)

For conditions arising from Qi disturbance: Oppose or follow, reverse or comply, unblock Qi to harmonize. Internal-originating diseases affecting external: treat internal first. External-originating diseases affecting internal: treat external first. If internal affects external strongly, treat internal then external. If external affects internal strongly, treat external then internal. If internal and external are unrelated, treat the primary disease.

Regarding treating cold with heat and heat with cold: If heat treated with cold remains hot, or cold treated with heat remains cold, due to new complications, how to treat? For heat persisting despite cold treatment, tonify Yin (strengthen Water to control Fire). For cold persisting despite heat treatment, tonify Yang (strengthen Fire to dispel Yin). Seek the affiliation. Taking heart herbs need not always be hot; taking kidney herbs need not always be cold. Benefit Heart Yang to circulate cold; strengthen Kidney Yin to manage heat.

Taking cold causes heat; taking heat causes cold. Why? Treating the Wang (Prosperous) Qi leads to reversal. If not treating Wang Qi, why? Because flavors belong to specific elements. Five flavors enter the stomach and go to their preferred organs: Sour to Liver, Bitter to Heart, Sweet to Spleen, Pungent to Lungs, Salty to Kidneys. Long-term use increases Qi, which is normal transformation. But long-term increase leads to premature death.