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Aoshu's scholarship and talent were comparable to those of Genzan and Yushou, with neither clearly superior. However, his dedication to profound contemplation and arduous study, combined with extensive practical experience, resulted in treatment techniques that often exceeded expectations. Generally, Aoshu followed other renowned physicians, benefiting greatly from their influence. Moreover, his reputation for treating sores and ulcers was unparalleled within the country; this success was due to his alignment with the times.

To excel in surgery (Waike), one must first master internal medicine. Why? Although sores and ulcers manifest in myriad ways, they all fall within the categories of Yin-Yang and Deficiency-Excess. If these are carefully examined and treated accordingly, there will be no unresolved issues in surgery. (Aoshu could respond flexibly to both internal and external conditions without error. His differentiation of pulse and symptoms was always clear. Furthermore, his integration of internal and external treatments was thorough.)

Those who study medicine should emulate the Neo-Confucian pursuit of principles. Without first investigating the physiological principles of the human body before examining diseases, one cannot reach the pinnacle of medical skill. (Zhuoxuan said: Master Aoshu often recited the phrase "medicine lies in understanding living things and exhausting principles" to guide junior practitioners. Before Western medicine was introduced, he had already focused on this. Thus, his technique of intercepting disease processes exhausted principles that Westerners had not yet explored. In the field of ulcerology, he was indeed a unique figure.)

Shiryo (Loss of Glory), Ki-in (Qi Goiter), and Uchuu-doku (Popliteal Abscess) were considered difficult to treat by earlier masters, and I also lacked effective methods for them. I once treated a craftsman at Hashimoto Post Station who had a tumor-like growth on the left side of his neck. I predicted, "This is Ki-in; he will likely bleed to death in a few days." This came true. Another patient with the same condition died from hemorrhage within four or five days. Regarding Uchuu-doku, the knee and shin muscles gradually atrophied, bone tips became black and necrotic, foul pus discharged, and the patient died. Physicians often claimed to treat this as Shidoku (Seasonal Toxin), focusing only on diffuse swelling of the lower legs. A woman from Kazusa Prefecture suffered from Shiryo. Her sore had not everted flesh, but she had trismus and difficulty eating. After trying Hogo-san (Five Treasures Powder), her swelling subsided slightly, and she could eat, but she eventually died. Another patient took Gokuseigan (Mercury Pill), experienced severe Mingxuan reaction (herxheimer reaction), and improved temporarily, but relapsed and died later.

Any mass that exhibits pulsation upon palpation is called a Dongmai (Arterial Pulse/Mass). It must not be needled recklessly. Mistaken needling will cause fatal hemorrhage.

For what is commonly known as Shenxian Lao (Immortal Labor/Chronic Consumption), prescribe Yi Gan Fu Pi San (Liver-Calming and Spleen-Supporting Powder) with Ezhu (Curcuma zedoaria) and Lingzi (Bletilla striata) as main ingredients, combined with Chensha San (Cinnabar Powder) or Zuojin Wan (Left Metal Pill). Recovery is expected.

Toxicity in the lungs invariably presents with a Shuo Mai (Rapid Pulse) and must not be ignored. Mild cough with sore throat, or expectoration of white foam with a rapid pulse, indicates Zhai (Consumption/Tuberculosis), which leads to death. For Xi Xue Xia Li (Blood Stasis causing Diarrhea), purgatives must not be used; purging will accelerate death. One must carefully examine abdominal signs and tongue color, treating with Qianjin Huang Tu Tang (Thousand Gold Yellow Earth Decoction) or Huanglian Jiedu Tang (Coptis Detoxification Decoction).

In Shanghan (Cold Damage) with sweating and aversion to cold, covering with clothes increases sweating, while removing them worsens aversion to cold, persisting for days without improvement. Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) or Guizhi Jia Huangqi Tang (Cinnamon Twig plus Astragalus Decoction) are ineffective. If delirium and anorexia develop leading to critical condition, two pathways exist: First, intense internal heat forcing fluids to the exterior, treated with Yebipi Tang (Yi Bo Decoction); second, exterior deficiency with profuse sweating, treated with Wen Jing Yuan Tang (Warm Meridian and Replenish Origin Decoction). (This syndrome must present with white spots on the tongue.)

An eight-year-old girl suffered from Wei Ruo (Flaccidity) in both legs, unable to stand. A blister appeared on the sole of her right foot, resembling a burn. Upon pricking, fluid drained, the blister ruptured, and a red halo formed around it, tender to touch. Two days later, blisters spread to the dorsum of the foot with edema, and toe tips turned black. This flaccidity impaired Qi and Blood circulation, causing toxic swelling. Initially, Guizhi Jia Zhu Fuzi Tang (Cinnamon Twig plus Atractylodes and Prepared Aconite Decoction) was given, along with periodic administration of Zi Yuan (Purple Pill) to purge, resulting in recovery. (This follows the lineage of Mr. Todoh; Mr. Tongaku also continued this tradition.)

For pit viper bites, administer Wutou Tang (Aconite Decoction) and Zi Wan internally, and apply Persimmon Fruit Juice externally for cure.

For Shi Lin (Stone Strangury) located in the penis rather than the perineum, surgical excision is required. The wound should be sutured and plastered. Inserting a Crane Feather Stem into the urethra to maintain patency is advisable.

For traumatic hemorrhage from severed vessels in hands or feet that does not stop, some physicians suture the vessel, worsening the bleeding. This is similar to tying above the Weizhong (BL40) or Quze (PC3) points during needling, which causes blood to flow out more freely; the principle is the same.

For early-stage Jie Lu (Cracked Skull/Open Fontanelle) in children, urgently administer Gegen Jia Zhu Fuzi Tang (Kudzu plus Atractylodes and Prepared Aconite Decoction) combined with Zi Yuan to purge. If the condition is fully established, purging will hasten death. (Zi Yuan treats upper toxicity; Qibao Wan treats lower toxicity. Sometimes named Qiankun Pills. This rationale is sound.)

Yellow vision in patients with wounds indicates Bleeding Exhaustion.

Wounds in the throat involving the airway are treatable if small, but untreatable if large. Esophageal wounds, even if larger, can often survive.

The formula for Po Shang Shi (Broken Injury Dampness) is found in *Zhengzhi Zhunsheng*, but Yebiji Jia Zhu Fuzi Tang (Yi Bo plus Atractylodes and Aconite Decoction) and Huzhang Jing Tang (Japanese Knotweed Stem Decoction) are more miraculous. (Zhuoxuan noted: Huzhang root disperses凝结 (condensation/stagnation); Huzhang stem treats Broken Injury Dampness and fire-heat burns, as seen in *Qingzhou Yitan*.)

Regarding Zang Du (Visceral Toxin): Inspect the anus for widespread corrosion resembling mung bean juice. Severe odor indicates Zang Du. If toxin is severe causing flesh eversion, it is mostly untreatable.

She Gan (Tongue Ulcer) can be cured in 80-90% of cases. First, excise necrotic tissue, primarily using fumigation therapy. However, if corrosion reaches the gums, it is untreatable. Epilepsy with tightly closed eyes, or dilated pupils, are also untreatable.

For chronic Ru Lou (Breast Fistula) that does not heal, start with Qudu Gao (Detoxifying Ointment), then switch to Zhangrou Gao (Flesh-Growing Ointment). Internally, administer Gegen Jia Zhu Fuzi Tang combined with Duan De Wan.

For condensed toxins, select Dahuang Mudanpi Tang (Rhubarb and Moutan Decoction) or Bozhou San.

For Fu Gu Ju (Necrotic Bone Abscess) near the chest, abdomen, or viscera, do not insert drains or apply caustics, as this may cause collapse.

For nodules on eyelids or lips, extraction towards the interior is optimal.

For Swollen Sores presenting with Liu Zhu (Flowing Deposit) characteristics, regardless of cause, Yebiji Jia Zhu Fuzi Tang is appropriate. (For early stages, this works; for long-standing cases, incision and drainage are necessary, otherwise there is no cure.)

Early Huang Dan (Jaundice) is signaled by three indicators: yellow eyes, epigastric fullness, and yellow urine. Even if skin color is normal, these three signs confirm the diagnosis. Recovery is indicated by the disappearance of yellow eyes.

For severe asthma/wheezing, Maxing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) or Maidong Tang (Ophiopogon Decoction) with Myrobalan (Meishi Zi) is effective. Myrobalan resolves sticky phlegm in the chest, though few physicians know this. (Zhuoxuan noted: Using Huzhang stem for Broken Injury Dampness and Myrobalan for asthma are discoveries of Master Aoshu, reflecting the pursuit of principles.)

For chronic diseases requiring mercury preparations, small doses administered long-term are key. It is like pouring a pot of water on dry ground in sunny weather; it leaves no trace. But pouring small amounts repeatedly penetrates thoroughly.

Zou Ma Gan (Running Horse Gangrene) is highly virulent, rotting gums and bones leading to death within days. If treated early when bad breath and bleeding occur, it can be saved.

In the sixth month of the 10th year of Bunka, an eight-year-old boy suffered from this. Necrosis reached the gums, and 3-4 teeth fell out. He was given Lulu Xiao Gan Yin (Aloe Reducing Ulcer Drink) combined with Renzhong Bai San (Human Urine Deposit Powder). Within ten days, he recovered, and teeth regenerated.

Although Dou Zhen (Smallpox and Measles) emerged in later periods, the differentiation of Yin-Yang and the use of warming/clearing methods are no different from treating Carbuncles and Sores. (Xu Shumi said: "One who can treat Shanghan can treat Dou Zhen; one who can treat Dou Zhen can treat Carbuncles. They enter through different paths—Shanghan vs. Carbuncles—but the principles are the same. Expert physicians share similar insights.")

For Wind Eye (Ophthalmia) with ulceration and uncontrolled bleeding, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) combined with Sanhuang Tang (Three Yellows Decoction) is effective. If pain persists after bleeding stops, Tongming Tang is given, and external steaming therapy is applied for cure.

For persistent head sores in women unresponsive to other medicines, Taohe Chengqi Tang (Peach Pit and Magnolia Bark Decoction) combined with Taohua San (Peach Blossom Powder) cures it. Applying Peach Kernel Oil is also effective.

For Cold Dysentery where purgatives were mistakenly used, worsening white pus, Dongjing Hezhong Tang restores harmony effectively.

For postpartum urinary incontinence, Shenqi Tang (Ginseng and Musk Decoction - *Note: Text says 'Can [missing character] Tang', likely Shenqi or similar*) plus Fuzi is effective. Increasing Yizhi (Alpinia oxyphylla) in the formula is particularly good. (Another prescription: Honghua (Safflower) and Yangshen (American Ginseng), each 1 liang. Pound them, place in a bird's crop, roast until charred outside but preserved inside, and take with warm wine.)

Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) treats spontaneous and night sweats. Its mechanism is similar to Chengqi Tang treating Yangming spontaneous sweating. This decoction also treats unilateral chest/hypochondriac pain caused by toxin pressing on the heart/chest. Physicians ignore this, treating only sweat and pain, thus failing to cure.

For acute postpartum diarrhea, Weifeng Tang (Wind-Stomach Decoction) brings quick recovery. If epigastric fullness develops after dozens of bowel movements, Shengjiang Xiexin Tang (Fresh Ginger Heart-Purging Decoction) is indicated.

Some say Zou Ma Gan resembles Ding (Carbuncle). I observe that fatal cases are indistinguishable from Ding. For asthmatics, Zijin Dan (Purple Gold Pill) induces vomiting of foul, turbid saliva/phlegm, leading to cure. Baisan (White Powder) also induces vomiting, but targets the lung tubes, whereas Zijin Dan targets the lung organs/fu-zang; their sites differ.

For early Jie Lu (Open Fontanelle), Gegen Jia Zhu Fuzi Tang with periodic Zi Yuan purges cures it. If it progresses to the size of a bucket, it is untreatable. For children with limb flaccidity, the former formula works, showing different symptoms but same toxicity. However, if flaccidity involves protruding spine or hemiplegia-like asymmetry, rapid cure is impossible.

Before administering Mafei San (Hemp Boiling Powder), one must first use Banxia Xiexin Tang (Pinellia Heart-Purging Decoction) to clear the epigastrium. Otherwise, it will not be effective. (This method evolved from the emetic techniques of Old Man Okamura.)

When considering Mafei San, examine the syndrome carefully. If blood flow is irregular, there is stagnant phlegm/fluid in the chest, or epigastric hardness exists, do not administer it. Treating the syndrome first, then operating, prevents errors. If no Mingxuan reaction occurs after taking Mafei San, surgery should not be performed, as it harms the patient. Dilated pupils and wiry-rapid pulse after taking Mafei San indicate the Mingxuan state.

For epilepsy with opisthotonos, muscle twitching, rapid breathing, or screaming, Gancao Ganjiang Tang is effective.

For early Uchuu-doku (Popliteal Abscess) with severe chills/fever, swelling/pain at Weizhong, followed by black necrosis, needling releases black blood without pus. Knee muscle atrophy resembles Tianxing Bing (Heavenly Punishment Disease). This is inherently untreatable.

Qi Tumors and Qi Goiters must not be touched recklessly, as this causes harm.

For early Jing Bing (Spasm), jaw stiffness is mandatory. Give Gegen Tang (Kudzu Decoction). Needling Hegu (LI4) and hairline is curative. If collapse signs appear, Shiquan Dabu Tang (Ten Complete Tonifying Decoction) plus Jingjie (Schizonepeta) and Fuzi, combined with Doulin Jiu (Bean Wine) with Jingjie, is used. However, severe opisthotonos preventing swallowing, or open mouth, are untreatable. (Transmission states: For spasm with clenched hands, needle Hegu 1.5-2 cun deep. Superficial needling at hairline is better; iron needles are best.)

For Po Shang Feng (Broken Injury Wind/Wound Tetanus), early neck/back stiffness, dysarthria, or chills are treatable with Gegen Tang or Xuming Tang class. Fructus Sapindus and Huzhang Jing decocted and taken orally are also effective. Opisthotonos is mostly untreatable. Postpartum spasms follow the same method.

Floating-slippery pulse in Jing Bing is auspicious; floating-rapid indicates recurrence.

A woman over fifty suffered from She Gan (Tongue Ulcer). The lesion resembled everted flesh, corroding to the gums. Caustic agents removed the everted flesh. She took Huanglian Jiedu Tang and received external fumigation for 100 days. Residual toxin cleared, and she recovered.

After fumigation, purgatives must be used to complete the cure. For She Gan, use Zi Yuan. If caused by Syphilis (Meidu), Longmen Wan is primary.

True Liu Zhu (Flowing Deposits) are rare nowadays. Current cases presenting as Liu Zhu usually have body scars, differing greatly from *Waike Zhengzong*.

A man in his twenties had diffuse axillary swelling with slight tenderness, resembling Pi Pi (Mass). His left foot had a scar. Diagnosed as exogenous Liu Zhu, he was treated with Yebiji Jia Zhu Fuzi Tang and periodic Zi Yuan purges, resulting in cure.

Liu Yin (Retained Fluids) combined with Xu Xue (Blood Stasis) requires precise abdominal examination to differentiate.

For He Xi Feng (Crane Knee Wind) or stubborn toxins hard to extract, Wutou Tang, Guizhi Jia Zhu Fuzi Tang, etc., plus Jiaoshi (Shell Ash) are suitable. Jiaoshi specializes in treating difficult-to-move toxins.

For Syphilis attacking and condensing the head/neck, Guizhi Tang plus Fuling, Cangzhu, Wutou, Xixin, Fangfeng, combined with Xiaodu Wan, is prescribed.

Linggui Zhugan Tang plus Fuzi treats Huang Pan Bing (Yellow Puffy Disease/Dropsy). Moving Qi in the chest is treated with Tie Fen (Iron Powder) and Shuqi (Polygala).

For Hernia needling: Clear fluid discharge means no suppuration. Bloody-fluid discharge implies suppuration. Suppurated hernias are easier to treat.

Intestinal Hemorrhoids with blood discharge are Excess; bloody-fluid discharge is Deficiency.

Ru Yan (Breast Cancer) with menstruation is easy to treat; amenorrhea makes it difficult. Pregnancy causes breast cancer nodules to enlarge suddenly.

Zhang Man (Distension/Fullness) arises from Water Qi or Qi Condensation. Water Qi is Excess, thus easy to treat. Qi Condensation is mostly Deficient, thus difficult.

Jixiong Yuanji said: Those dying of distension have solidified intestinal masses upon cremation, hard as stone. Westerners note that abdominal distension with tubercles obstructing limb blood vessels leads to wasting of limbs. This may be true.

Kuang (Mania), Xian (Epilepsy), and Xue Yun (Blood Fainting) are similar but distinct. Mania involves incessant nonsense speech. Epilepsy involves fright and opisthotonos triggered by stimuli. Blood Fainting involves mental confusion, severe trismus. Sweating and pulse lacking Stomach Qi indicate death.

For dog bites, apply Zhonghuang Gao (Central Yellow Ointment) with Xingren and Gancao externally. Internally, Huanglian Jiedu Tang plus Muguaizi (Momordica seed), and eat Toad meat. This is excellent.

For Tuo Ju (Gangrene of Extremities), pain indicates non-necrotic tissue; absence of pain indicates necrosis.

Lin Ji (Strangury) with free urination is treated with Shenqi Tang plus Fuzi.

Shoulder stiffness, lower back pain, left hand wound, right hand mass, and generalized pain indicate Liu Zhu Du (Flowing Deposit Toxin). Treat with Yebiji Jia Zhu Fuzi Tang and periodic Zi Yuan purges. For collapse, use Shenqi Guifu agents.

Metal wounds in the diaphragm are fatal regardless of speed. Wounds above the navel are dangerous. Abdominal wounds avoid caustics because they are near viscera.

Fan Shi, Badou, Banzhao, Wutou, etc., are hot toxins. Cold water is best for detoxification. (Note: All potent toxins in nature are acrid-hot. Detoxifying herbs are therefore bitter-cold, such as Huanglian Jiedu Tang and Kushen Tang.)

Caustic drugs cause the most severe Mingxuan reactions. One patient applying caustics to the buttocks died from sudden upward attack of toxin to the heart.

Mild Mingxuan from caustics includes chills, fever, thirst, or anorexia. Severe cases involve irritability/thirst or oppression, with toxin pressing on the epigastrium, hastening death. Urgently rescue with Huanglian Jiedu Tang or Ganlian Jia Shigao Lutou Tang (Licorice-Coptis plus Gypsum and Mung Bean Decoction).

Postpartum shivering is due to fresh Qi/Blood deficiency and pathogen invasion. Give Jingjie Chenxiang Tang or Shiquan Dabu plus Jingjie and Paojiang. For greater deficiency, add Fuzi. Shivering occurring 4-5 times is difficult to treat. Slow pulse indicates recovery; tight-rapid pulse indicates untreatability.

Postpartum blood deficiency with red, ulcerated, painful tongue is treated miraculously with Bayi Tang plus Lutai Shuang (Deer Placenta Frost). Lutai Shuang also treats postpartum continuous bleeding.

General body pain is generally due to Qi/Blood stagnation, such as in trauma or Tianxing Bing. Qi-moving agents bring cure.

Hernia originates in the lower abdomen, causing rectal prolapse into the scrotum. Differentiate ease/difficulty. Gradual unilateral scrotal swelling is easy to treat. Scrotal fluctuation with pain radiating to lower abdomen is difficult. I once needled a case of scrotal fluctuation, causing foul-smelling stool passage, which was distressing. Syphilitic hernia forming hard flesh should be cut with scissors; caustics cause harm.

Wei Yuan Yong (Stomach Abscess) mimics Fei Yuan (Lung Abscess) but pain extends to lower abdomen with expectoration of pus/blood. Treat with Pai Nong San (Pus-Expelling Powder) or Jiegeng Bai San (Platycodon White Powder). Early Jie Lu in children begins with fever, trismus, and opisthotonos. Treat early with Gegen Jia Zhu Fuzi Tang plus Zi Yuan. Once established, it is mostly untreatable.

Opisthotonos without vomiting/diarrhea is Ji Jing Feng (Acute Infantile Convulsion). Tremors with upward gaze, vomiting/diarrhea are Man Jing Feng (Chronic Infantile Convulsion). Treat with Sini Tang, Chaihu Yi Gan Tang, Xingxing San, Qingpi San, or Deliya (likely a specific formula name) according to syndrome. Hou Tou used Chaihu Jia Longgu Muli Tang; efficacy unknown. Acute convulsions show lucidity between attacks; chronic shows sleepiness. Chronic convulsions with preceding coma are mostly untreatable.

For Pian Ku (Hemiplegia) regardless of age, Guizhi Jia Zhu Fuzi Tang is usable. For urgency, purge with Zi Yuan. Abdominal softness indicates treatability; rigidity indicates untreatability. This is due to lack of Qi circulation; purging does not relieve rigidity.

Stroke-related hemiplegia with periodic onset often belongs to Epilepsy families. Guizhi Jia Ling Zhu Fuzi Tang with periodic Zi Yuan purges is used. Long-term medication is necessary. Women with uncontrollable arm flexion/extension have epilepsy, treated with Daqi Qi Tang with miraculous effect. (Zhuoxuan: These dozens of cases are practical truths, reflecting the Master's spirit. Students should regard them as golden rules.) Former disciple Fukuba Kataoka (Courtesy name Shike, Village Physician) liked my words, copied them from my book, and wrote a preface: "Master's medicine integrates internal and external principles, adapting to syndromes practically. Formulas have standards, techniques have flexibility. Juniors must study this." He asked me to correct the draft. At that time, Kataoka died suddenly of foot disease. Later, I wrote this. I edited the manuscript to honor his legacy and added a poem: "Years ago we enjoyed wandering together, / Who counted the loss, suddenly one autumn passed. / The waning moon shines through the window, the person unseen, / Sky full of wind and dew drips on the empty tower."