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Diseases differ in deficiency (Xu), excess (Shi), cold (Han), and heat (Re); therefore, medicines differ in tonifying (Bu), purging (Xie), warming (Wen), and cooling (Liang). If a deficiency pattern is complicated by excess, or an excess pattern by deficiency; if cold transforms due to heat, or heat transforms due to cold; or if there is cold above and heat below, or heat above and cold below—the symptoms are various. Thus, the methods of prescribing medication in clinical practice must be understood.

In the past, the sister-in-law of Han Mao suffered from sores on her mouth, tongue, and lips, extending to block the throat, while suffering from lower body deficiency collapse and profuse leukorrhea like a gush. Physicians who administered cooling agents to resolve the upper heat found that the lower pathology worsened. Those who administered heating agents or fumigated the lower body with decoctions caused dizziness and near-syncope. Han Mao stated, "This is Yang exhaustion (Wang Yang)." He used salt-processed Fuzi (Prepared Aconite Root) as the sovereign drug, moderated it with Bohe (Mint) and Fangfeng (Saposhnikovia Root), assisted by Jiang (Dried Ginger), Rougui (Cinnamon Bark), Chuanxiong (Ligusticum Rhizome), and Danggui (Angelica Sinensis Decoction). The decoction was cooled in well water before administration. Before the dose was finished, the condition improved slightly. When asked for the rationale, he replied: "True addresses true, false addresses false. The upper part presents false heat, so false-cold medicines are used to follow it. The lower part presents true cold, so true-hot medicines are used to counteract it." Thus, the upper and lower harmonized, and the disease resolved. This is the method for treating false heat and true cold.

Zhang Rui treated the granddaughter-in-law of Cai Lugong, who, the day after childbirth, suffered severe diarrhea and throat closure preventing food intake. Other physicians said, "These two ailments are like ice and charcoal; even a life-saving deity could do nothing." Zhang Rui said, "Do not worry." He took dozens of pills for her to swallow; immediately, her throat opened, and the diarrhea stopped. Mr. Cai was amazed. Zhang Rui explained, "This is not recorded in the classics; I treated it based on my understanding. The medicine previously used was actually Fuzi Lizhong Wan (Aconite Pill to Regulate the Middle), wrapped in Zixue (Purple Snow). When the throat was closed, only extreme cold medicines would be effective. Once swallowed, the effect dissipated completely. What reached the abdomen was the power of Fuzi, so one dose cured both ailments." This is the method of treating cold and heat simultaneously.

Luo Qianfu treated a woman with Liver-Spleen Qi stagnation and depression. In the morning, he prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) followed by Liuwei Wan (Six-Ingredient Pill with Rehmannia); in the afternoon, Xiaoyao San (Free and Easy Wanderer Powder) followed by Guipi Tang (Restore the Spleen Decoction). This is the method of treating Qi and Blood simultaneously. Luo Qianfu also treated another woman with Liver-Spleen Qi stagnation, administering Guipi Tang followed by Lushui Wan (Aloe Pill). This is the method of combining tonification and purgation.

Xue Xinpu treated a woman whose anger injured the Liver, resulting in simultaneous deficiency of Qi and Blood. He prescribed Xiaoyao San in the morning and Guipi Tang in the evening. He also treated another woman whose depression and anger injured the Liver and Spleen, prescribing Guipi Tang in the morning and Xiaoyao San in the evening. In the first case, Liver Yin was severely damaged, so Xiaoyao San was used first to soothe the Liver Wood, followed by Guipi Tang to tonify Spleen Earth, preventing Wood from overacting on Earth. In the second case, Spleen Earth was already controlled by Liver Wood, so Guipi Tang was used first to strengthen the deficient Spleen against the strong Liver, followed by Xiaoyao San to soothe Qi, allowing Liver Wood to flow freely without suppressing Earth. This is the method of addressing symptoms and root causes in a specific sequence.

Li Dongyuan treated accumulations such as Xiben and Fuliang using pills. Initially, patients took two pills, increasing by one pill on the first day and two on the second, until stools became slightly loose. Then, they restarted from two pills, cycling repeatedly, stopping when the accumulation had reduced by more than half. This prevents heavy medication from damaging healthy Qi in mild cases, employing the method of gradual increase.

Li Shicai formulated agents for Yin and Yang accumulations. He would tonify for several days, then attack the accumulation. Regardless of how much was removed, he would resume tonification until the patient's spirit recovered, then attack again. This repeated cycle of attacking and tonifying continues until balance is achieved. This is the method of alternating attack and tonification.

I applied these methods to treat eye diseases with immediate efficacy. For example, Shen suffered from red, swollen eyes with purulent discharge, dry mouth and lips, and dark, scanty urine—a case where Kidney Water cannot control the Five Fires. Merely clearing fire does not generate water quickly; merely nourishing water does not extinguish fire abruptly. Therefore, I used Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) to administer Qingning Wan (Green Peace Pill), clearing fire while strengthening water.

Another case involved Yao, whose right eye was injured by a plant thorn, causing white opacities and unceasing pain. Treatment should focus on invigorating blood as the root and regulating Qi as the branch. I prescribed Siwu Tang (Four Substance Decoction) with Sumu (Calamus Wood), Honghua (Carthamus Flower), Ruxiang (Frankincense), Moyao (Myrrh), and E chong (Ground Beetle) in the morning to move blood, and Chenxiang Yueju Wan (Agarwood Free and Unstuck Pill) in the evening to regulate Qi.

Gan suffered from eyelid eczema after smallpox, caused by deficiency, stagnation, and heat lingering in the Spleen and Stomach. The root is supporting the Spleen; the branch is clearing heat. I prescribed Liujunzi Tang (Six Gentlemen Decoction) minus Gancao (Licorice), plus Shengma (Cimicifuga Rhizome), Wangyuesha (Hare Feces), and Xingren (Apricot Seed) in the morning to strengthen the Spleen and moisten the Lungs, and Qingmu San (Clear Eye Powder) in the evening to drain fire.

Li suffered from red opacities in both eyes, with intermittent pain during the day, indicating disharmony of Yang. I prescribed Xiangsha Liujunzi Tang (Atractylodes and Amomum Six Gentlemen Decoction) in the morning to harmonize Yang. However, since Upper Jiao Qi stagnation remained unresolved, I also used Biyun San (Blue Cloud Powder) insufflated into the nose to diffuse Qi.

Ma suffered from red pterygium in both eyes, with intermittent pain at night, indicating disharmony of Yin. I used Bugan San (Tonify Liver Powder) combined with Siwu Tang to harmonize Yin. However, floating Fire ascends and must be descended, so I applied cooked Shudi (Prepared Rehmannia Root) and Fuzi (Prepared Aconite Root) mashed together to the Yongquan acupoint (KI1) to descend floating Fire.

Liu suffered from blurred vision, chest oppression, and irritability, caused by Kidney Water failing to nourish Liver Wood. I used Zuogui Yin (Left Restoring Decoction) administered with Yueju Wan to strengthen Water while resolving stagnation.

These examples illustrate mutual assistance between Yin and Yang, simultaneous regulation of Qi and Blood, and combined treatment of deficiency and excess. Not all methods can be listed here; I have briefly described a few to help students infer others from one instance. Some ask, "Why not combine everything into one decoction?" I reply: Prescribing is like military strategy. If two armies approach along the same path, merging forces to attack ensures success. But if enemies attack from east and west separately, merging forces leads to scattered efforts and lack of focus. It is better to divide forces to achieve victory in each theater. Yet, orthodox and unorthodox tactics vary by individual, aiming for maximum flexibility. As the Art of War states: "He who calculates more wins; he who calculates less loses."