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I have examined Mr. Zhang Tongyi's view, which states: Treatment involves either contrary (Ni) or following (Cong) methods because diseases vary in severity. Disease severity varies because syndromes present as either true (Zhen) or false (Jia). Cold and Heat syndromes also have true and false distinctions. Consequently, treatment methods also have true and false applications. True conditions are treated with standard treatment (Zheng Zhi), which is not difficult. False conditions require reverse treatment (Fan Zhi), which is the challenging aspect.

Regarding the true and false nature of Cold and Heat:
True Cold presents with a deep (Chen) and fine (Xi) pulse, or a deep and slow (Chi) pulse. Symptoms include cold limbs (Jue Ni), vomiting, abdominal pain, diarrhea with undigested food (Can Xie), watery diarrhea (Xia Li), and clear, frequent urination. Even if fever occurs, the patient desires to wear clothes. This indicates floating heat on the exterior and sinking cold within.
True Heat presents with a forceful and rapid (Shu) pulse, slippery (Hua), large (Da), and solid (Shi). Symptoms include restlessness (Fan Zao), asthma and chest fullness (Man), loud and harsh voice, constipation, or scanty, red, and painful urination. The patient may throw off clothes due to fever, or experience abdominal distension, pain, heat, and thirst for cold drinks. These are all true diseases and true Heat syndromes. For true Cold, one should warm the cold; for true Heat, one should directly resolve the heat. Both are examples of standard treatment (Zheng Zhi).

False Cold is when Yang syndromes mimic Yin, or extreme Fire mimics Water. Although the exterior feels cold, the interior is hot. The pulse is rapid and forceful, or deep but beating forcefully upon palpation. The patient may feel cold and dislike clothing, yet have dry, bound stools that are hot, or experience irritability, thirst with desire to drink, or foul-smelling intestinal discharge. This is "aversion to cold" that is not true cold, clearly a Heat syndrome. It is referred to as "extreme heat manifesting with cold transformations," also known as "Yang excess blocking Yin."

False Heat is when Yin syndromes mimic Yang, or extreme Water mimics Fire. Although the exterior feels hot, the interior is cold. The pulse is faint (Wei) and weak (Ruo), or rapid but empty (Xu), or floating and large without root, or wiry (Xian) and hollow (Kou) with intermittent beats. The body may be burning hot, but the spirit is calm; speech may be delirious, but the voice is weak; or there may be virtual mania with falling, which stops when restrained. Skin spots may appear like mosquito bites, light red and fragmented. The patient may prefer cold water but drink little, or have a red tongue coating but refuse to remove blankets. Urination may be frequent, and stools may not be bound. This is "aversion to heat" that is not true heat, clearly a Cold syndrome. It is referred to as "extreme cold manifesting with heat transformations," also known as "Yin excess blocking Yang."

For False Cold (internal heat with external cold symptoms), one should clear the internal heat; once internal heat is cleared, the floating heat will retreat. For False Heat (internal cold with external heat symptoms), one should warm the true Yang; once true Yang is warmed, the defire fire will return to its origin. This constitutes following treatment (Cong Zhi).

Regarding the treatment of Deficiency (Xu) and Excess (Shi): Excess is treated by purging (Xie), and Deficiency is treated by tonifying (Bu). This is an unchangeable principle. However, extreme Deficiency can present with signs of Excess, called False Excess; extreme Excess can present with signs of Debility, called False Deficiency.

In summary, Deficiency refers to the deficiency of Right Qi (Zheng Qi). It manifests as a dismal complexion and mental fatigue, weak spirit and cowardly Qi, spontaneous sweating that does not stop, incontinence of urine and feces, nocturnal emission during sleep, vomiting and obstruction, excessive purgation over a long illness, shortness of breath resembling asthma, excessive labor injury, or sudden exhaustion and loss of will. Although external signs may resemble Excess, if the pulse is weak and lacks spirit, it is a Deficiency syndrome and should be tonified.

Excess refers to the abundance of Pathogenic factors (Xie Qi). Pathogens may close the meridians and collaterals externally, or knot in the zang-fu organs internally. Qi may be stagnant and unable to move, or blood may coagulate and stagnate. Only when both the pulse and disease manifestations are vigorous is it an Excess syndrome requiring attack/purging.

However, Deficiency and Excess are often confused, and their truth must be distinguished. As stated in *Tong Ping Xu Shi Lun*: "When pathogenic factors are abundant, it is Excess; when essential qi is depleted, it is Deficiency." This is the general principle of Deficiency and Excess. Suppose a person has depleted Right Qi while Pathogenic factors are abundant. Should one protect the Right Qi and tonify first, or eliminate the Pathogen and purge first? If the judgment is inaccurate, life and death depend on it, so caution is required.

Right Qi is the root (Ben); Pathogenic factors are the branch (Biao). If Right Qi is already deficient, even if Pathogenic factors are abundant, one must not attack. For fear that the Pathogen may not be expelled before the Right Qi collapses, leading to immediate changes in respiration and life, making it impossible to handle the situation. Therefore, when treating mixed Deficiency and Pathogenic conditions, one must first protect the Right Qi. If Right Qi is preserved, harm will not occur. Moreover, tonification contains the intent of purging. Tonifying Yin clears Heat; tonifying Yang disperses Cold. There is no case where Right Qi recovers while Pathogens remain, nor is there a case where Right Qi exhausts while life is preserved. If absolutely necessary, one must weigh urgency and slackness, adopt temporary expedients, and adjust the ratio of tonification and purging, embedding attack within defense. This is the method for treating Deficiency.

If Right Qi is undamaged, even if Pathogenic factors are slight, tonification is inappropriate. Tonification would benefit neither the Right Qi nor the Pathogen, but rather strengthen the Pathogen, akin to providing weapons to bandits and grain to thieves. Therefore, when treating Excess, one should directly eliminate the Pathogen. Once the Pathogen is gone, the body is safe. The method must be precise and specialized to achieve rapid effects. This is the method for treating Excess.

Ultimately, only those who can withstand purging are truly Excess; Excess can be attacked, so why worry? Those who cannot withstand purging are Deficient; if Qi departs and does not return, one should be terrified. This understanding of the root and branch of Pathogenic and Right Qi is indispensable.

False Deficiency syndromes are rare, while False Excess syndromes are common. False Cold is not difficult to treat, whereas False Heat is often mistreated. Generally, Excess tends toward Heat, and Deficiency tends toward Cold. As Zhu Danxi said: "Excess of Qi becomes Fire." Thus, Excess conditions can tolerate Cold herbs. I add: "Deficiency of Qi becomes Cold." Thus, Deficiency conditions can tolerate Warm herbs. In the world, those who do not understand the true and false, root and branch, yet claim to know medicine, I dare not endorse.