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A guest expressed doubt regarding Xu Lingtai's (Xu Dacun) assertion that "quack doctors bear no guilt for killing people." I responded, "Why do you ask about quack doctors? Even renowned physicians of the contemporary era often possess only faults and no merits. When a person contracts a disease by chance, they respectfully invite a physician to treat them. The entire household is in a panic, like drought-stricken land longing for rain, treating the doctor with reverence akin to deities and serving them as one would a tutor or guardian. If there is occasional efficacy and success, gold and silk are offered as rewards; if a mishap occurs, it concerns life and death—who can be blamed for the fault? Quack doctors commit various sins; their crimes are too numerous to count even if all their hair were pulled out."

The guest requested a detailed discussion. I said, "There are quacks who are fraudulent. They cater to the patient's preferences, employing every stratagem to flatter and comply. Whether tonification or purgation, warming or cooling is indicated, they always guide treatment according to the patient's wishes, completely disregarding the etiology of the disease and whether the patient lives or dies. There are quacks who are arrogant. After diagnosis, they demand to see the prescription written by the previous physician. Regardless of its correctness, they invariably propose opinions diametrically opposed to it, boasting of their own strengths and belittling others' weaknesses. If the condition takes an unexpected turn, they claim, 'It was due to the mistaken administration of such-and-such medicine.' There are quacks who are pedantic. They are stubborn and inflexible, adhering rigidly to fixed rules. How can they know that diseases manifest in myriad ways? Morning may require warming and tonifying, while evening requires clearing heat and resolving exterior symptoms. Or, if a patient has a naturally cold constitution, the disease may still require cooling herbs like Scutellariae Radix (Huangqin, 黄芩) and Coptidis Rhizoma (Huanglian, 黄连); if a patient has a naturally hot constitution, the disease may still require warming herbs like Cinnamomi Ramulus (Guizhi, 桂枝) and Aconiti Lateralis Radix Praeparata (Fuzi, 附子). If one strictly adheres to preconceived notions, believing there is only one correct use for medicines and no variation in diseases, encountering such rapidly changing symptoms or conditions contrary to the patient's usual state will lead to immediate disaster. There are quacks who are shallow and vulgar. They follow the crowd without independent judgment, echoing others' words. Their pulse diagnosis is neither precise nor thorough, and their familiarity with herb properties is lacking. They merely agree with others, daring not to offer different opinions. Patients deeply appreciate their accommodating and easy-going nature. They prescribe bland formulas and gain widespread recommendation, becoming known even among women and children. They consider themselves free from responsibility throughout their lives; how can such intentions be condoned?

"There are also eccentric individuals who falsely claim affiliation with the Wu School of Ye Tianshi. They neither study the *Shennong Bencao Jing* (Divine Farmer's Materia Medica) nor observe Li Shizhen's *Bencao Gangmu* (Compendium of Materia Medica). They casually select common, inconsequential items, boasting of their miraculous effects, yet they are ultimately mismatched with the symptoms, causing profound harm. This is quackery masquerading as sophistication. There are shallow practitioners who habitually use a limited set of prescriptions, relying on merely over ten types of herbs. When ridiculed, they excuse themselves by citing Xue Lizai, a grandmaster of medicine, whose successes often stemmed from only three formulas: Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Xiaoyao San (Free and Easy Wanderer Powder), and Guipi Tang (Restore the Spleen Decoction). Perhaps Xue Lizai mastered these, but later generations still criticized him for being rash and ignorant. How much more so for those相差十倍百倍 (ten to a hundred times inferior) to Xue Lizai? Is this not like Dongshi imitating Xishi's frown? This is quackery resulting from bias. There are local literati who are somewhat clever, having glanced at medical texts but having no ambition in the medical way. Unaware observers, noting their superior literary skills and sharp arguments, insist that families invite them to consult on medical matters. They secretly alter herbal ingredients behind the scenes. If successful, they take credit; if failed, they shift blame. What space is left for the actual physician to demonstrate skill? This is quackery relying on trickery. There are outsiders from distant places who deceitfully claim expertise in acupuncture and surgery, asserting proficiency in all aspects, yet possessing no real strength. In acupuncture, they experiment on patients' skin and flesh; in surgery, they first apply caustic agents to enlarge ulcers, making healing difficult, instilling fear and trembling in patients before taking over treatment. Moreover, they cannot guarantee victory, leading to death in seven or eight out of ten cases. This is quackery engaging in reckless behavior. They even use heavy drugs for mild conditions and light drugs for severe ones, reversing right and wrong, displaying exaggerated tricks. They fail to understand that the benefit of medicine lies in treating the syndrome: where there is a syndrome, there is a corresponding drug. How can one ignore the syndrome and deliberately reverse the medication? Acting against the natural order, few syndromes would not worsen. Yet patients often fall into their traps, thinking that since the theory differs from the ordinary, it must be based on extensive experience (nine broken elbows). This is truly quackery characterized by gross error. They even label curable diseases as difficult and difficult diseases as curable. Consider that labeling the difficult as easy inevitably leads to using mild drugs for serious illnesses; labeling the easy as difficult inevitably leads to using exotic and harsh drugs for simple illnesses. If patients lack discernment, such mismatch between drug and disease ensures that the difficult becomes harder and the easy becomes difficult. Once errors occur, how can they be salvaged? This is quackery that is extremely detrimental. Furthermore, some are insatiably greedy. Upon encountering wealthy families, knowing the condition is critical, they prevent hiring other experts to attempt rescue. They delay treatment to prolong the opportunity to earn money, until the patient is on the verge of death, helpless, and the family curses them, fleeing in haste. This is quackery that has lost its mind. Some even curry favor with powerful officials. High-ranking officials often have fixed ideas in mind. Even when suffering from Cold Damage (Shanghan, 伤寒), Summerheat-Dampness (Shushi, 暑湿), etc., they insist on using potent tonics like Ginseng Radix et Rhizoma (Renshen, 人参), Prepared Aconite Root (Fuzi, 附子), Zingiberis Rhizoma (Ganjiang, 干姜), and Rehmanniae Radix Praeparata (Shudihuang, 熟地黄), believing that nourishing primordial Qi absolutely precludes the use of bitter-cold dispersing drugs that might damage the body. Physicians, fearing to offend their taboos, make mistake after mistake, leading to myriad complications. Alas! Although they are nobles and ministers, because they lack their own judgment and consult me, yet I cannot assert authority, prioritizing their wishes over their lives—how unjust is this? This is quackery lacking resolve.

"The guest, hearing my words, jumped up and said, 'You have depicted quack doctors with such vivid detail; what guilt will you escape in this world? Moreover, Lingtai is a renowned physician of our dynasty. Why are his comments so absurd?' I said, 'This is likely not Mr. Lingtai's actual words. Lingtai authored six works; his words are exquisite and worthy of transmission. In his tone and spirit, he never showed leniency toward quack doctors. In his *Essay on Ginseng*, he stated that modern physicians kill people in places unknown to heaven, and thus heaven's punishment also falls in places unknown to humans. In his *Essay on Prescriptions*, he stated that what is nominally for health preservation is actually hastening death; the bad habits of itinerant healers are what sages must condemn. These are his handwritten verdicts. How could he suddenly exonerate quack doctors? How could he condone their killing under the pretext of minor merits? Furthermore, his argument is baseless and absurd. If he says life and death are predetermined, then whether one dies young or lives long is governed by fate; why say fate has no power? If he says illness inevitably arises, causing untimely death, then the onset of illness is also governed by fate. Can fate cause illness but not death? If fate's power is supreme here, yet it must rely on physicians to make mild conditions severe and severe conditions fatal, then fate's power is subordinate to physicians. Why speak of supremacy? I believe this demonstrates ignorance of both fate and Heaven. Consider: what can Heaven not do to cause death? To let healing physicians act as messengers of the underworld—is it true that the more they kill, the greater their merit? Stealing the merit of killing, striving to emulate Hua Yuan killing Cao Geli, and eventually succeeding, would indeed make one a meritorious minister of the Han dynasty. However, wanting to kill but being unable to do so shows that power still rests with Heaven's mandate, not something physicians can seize. Therefore, Duke Zhang Wenzheng said that a person's fortune and lifespan will not be mistakenly ended by physicians. Even if drugs are misadministered, it results only in increased suffering. This is a balanced view held by Confucian statesmen. Physicians must not use this as an excuse; it only emboldens quacks to kill. Moreover, the text itself is contradictory. As mentioned above, ill-intentioned acts harming countless people are rarely punished by Heaven; below, it mentions deceitful intentions and profiting from fake drugs, where disasters arrive immediately. Even if Lingtai wrote it, it would be mere playful writing. During proofreading, no one checked it, and it was publicly titled 'No Guilt for Misleading People' and attached to the end of the volume, contradicting the original intent. This is truly strange. My heart is originally foolish and unlearned, harboring only compassion. For the incurable, since I cannot raise the dead, and for the curable, I treat them多方 (in many ways), achieving efficacy upon trial. However, constrained by circumstances, I cannot refuse payment like Lingtai. Scrutinizing my conscience at night, my sins accumulate. I write this to warn others and myself. The guest nodded repeatedly and raised a large cup of wine to drink.

Master Xinchan, a master of medicine, enumerated the crimes of quack doctors misleading people, as clear as casting a tripod or lighting a rhino horn to reveal spirits; how could anomalies hide? Even if Lingtai rose from the nine springs, he would surely smile at each other and slap the table in admiration. As for the vigorous writing style, layer upon layer of refutation and questioning, thoroughly satisfying and incisive, this is achievable only by one who has immersed themselves in the *Records of the Grand Historian* (Shiji, 史记) and *Book of Han* (Hanshu, 汉书) for ten years. (Your younger brother Songqiao reads with respect.)