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Whenever respiration is faint, speech is reluctant and weak, movement is fatigued, food intake is reduced, the body shivers with cold, the physique is withered and emaciated, dizziness occurs, and the complexion is pale, these are all signs of true deficiency and pure deficiency. As mentioned by former sages regarding "deficiency of both Qi and Blood," urgent use of Ba Zhen Tang (Eight Treasure Decoction) or Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction) for vigorous tonification is indicated.

[M Xu Rongzhai's Note] Regarding the symptoms of "Qi deficiency" and "Blood deficiency," He Shi's *Chong Ding Guang Wen Re Lun* (Revised and Expanded Treatise on Warm-Heat Diseases) also contains relatively clear records. He stated: "The indications for tonifying Qi deficiency are: a sallow and pale complexion, faint voice, weakness in the four limbs, panting upon exertion, epigastric fullness with much phlegm, difficulty digesting food leading to sour regurgitation, dizziness with spontaneous sweating, loose stools, cough with shortness of breath, and a white tender tongue coating or pale red and moist tongue. The indications for tonifying Blood deficiency are: pale face and lips, dizziness and blurred vision, five-palm heat with thirst, restlessness of the mind, forgetfulness, palpitations, insomnia, dry intestines with difficult defecation, dry mouth with atrophic tongue or sores on the mouth and tongue; a tender red and dry tongue coating, or crimson base with floating white coating, or crimson and dry tongue body."

Some cases arise from patients whose constitutions were originally strong, while others arise from excessive exogenous pathogens. Patients with originally strong constitutions will likely suffer fewer illnesses. If they do fall ill, it is mostly excess patterns involving both exterior and interior. If release via sweating is indicated, release the exterior; if purgation is indicated, purge the interior. It is essential to eradicate the root cause of the disease. In cases of excessive exogenous pathogens, such as skin heat indicating Lung excess, surging pulse indicating Heart excess, abdominal distension indicating Spleen excess, chest oppression and confusion indicating Liver excess, and obstruction of both anterior and posterior orifices indicating Kidney excess—these correspond to the "Five Excesses" described in the *Huangdi Neijing* (Yellow Emperor's Inner Canon). One must first address the most urgent aspect by draining the excess.

There are cases where the upper part is deficient and the lower part is excess, which corresponds to latent heat in the Blood level. Although external symptoms often resemble deficiency-cold, there may be slight thirst, slight constipation, slightly reddish urine, and a fine and rapid pulse. Treatment must first clear the blood collaterals and unblock the Qi mechanism. In severe cases with dry throat, thirst requiring drinking, five-palm heat, scanty urine, and constipation, one should rescue the Yin fluids to nourish Yin. There are also cases of Yin excess with Yang deficiency, corresponding to the pattern of Yang sinking into Yin. Symptoms include heavy body and joint pain, bitter taste in the mouth, dry tongue, night fever with irritability, loose stools, and frequent urination. Although the presentation may seem like dampness excess and Yin dominance, or heat accumulation and fire flaming upward, if there is aversion to cold with shivering, profound melancholy, and a deep and firm pulse, this indicates that Clear Yang fails to ascend and Stomach Qi sinks due to deficiency. Initially, use methods to raise Yang and scatter fire; subsequently, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to lift the sinking Qi. One must strictly avoid using methods that nourish Yin and descend fire.