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When I was young, I read the therapeutic books of the sages. Privately, I thought they were either too rough and crude or overly detailed and dense, which did not align with my own views, so I did not finish reading them. Therefore, I took the classics of Master Zhong (Zhang Zhongjing) and focused entirely on studying them. I briefly glimpsed the intent of their compositions and verified them through medical practice. After decades, when I finally read the works of various schools, I realized that the sages possessed unique and superior skills. I regretted not being humble and contemplative at that time. From then on, by continuing to explore and deduce, reaching the realm of the ancients was not difficult. Alas, the sun is setting and the road is long; I can no longer keep pace with them to establish my own school. However, I cannot stop myself. I will tentatively record a few points here as a resource for the understanding of younger generations.

In recent times, the study of ancient prescriptions has been led by Nagoya Gen'i and Kawam Tenmin, but they inevitably retained the bad habits of the Jin-Yuan period. It was Mr. Gensan who heroically rose up, thoroughly washing away the previous弊端 (malpractices). His insights and therapeutic methods must have been significantly different from his predecessors. The world considers him curious (novelty-seeking), which is incorrect. Generally speaking, our medical arts had become fragmented and extremely depleted by the time they reached the lineage of Yixi and Daosan. Thus, it was natural for physicians in the Gen'yo era to turn back to antiquity. (Zhuoxuan said: "The entire work *Shangfeng Yueyan* reflects Mr.'s core competence; he can be called one who truly understands the *Shanghan Lun*. Later heroes emerged, inspired by his demeanor; this marks the revival of our path. Mr.'s starting point here was not accidental.")

Grains, meats, fruits, and vegetables possess "correct nature" (balanced properties). Herbs, trees, insects, and minerals possess "deviant nature" (potent/strong properties). Therefore, in ancient times, correct nature was used to nourish essence, while deviant nature was used to treat disease. Later generations did not understand this principle and attempted to use medicines to tonify essence and qi, which was a mistake. (*Suwen* states: "Five grains for nourishment, five fruits for assistance, five vegetables for supplementation; toxic substances attack pathogens." This is the general guideline for physicians. Mr. highlighted this early on, laying the foundation for later arguments by Dongdong and others.)

In chaotic times, people's temperament is fierce and rash, with less liver-gallbladder qi stagnation. In peaceful times, people's temperament is idle and sluggish, with more liver-gallbladder qi stagnation. Therefore, it is appropriate to use bear gallbladder to open stagnation and allow liver-gallbladder qi to flow freely. (Yongfu Feng said: "I have verified this among people in cities and markets; it is ubiquitous. Perhaps due to long periods of peace, population growth, financial waste, and increasing luxury, intelligent people inevitably suffer from 'qi momentum' diseases. Physicians who work on this aspect during treatment will gain great benefit.")

If a person has *pi* (accumulations/masses) and reduced appetite, it is like a house where corridors collapse and side rooms decay, causing the main hall to gradually shrink. If *pi* is not removed, the stomach cannot revitalize. Doctors who do not understand this logic and attempt to tonify stomach qi with toxic drugs, while neglecting diet and further damaging essence and fluids, are acting absurdly. To treat such conditions, one must first expel *pi*, focusing primarily on nourishing stomach qi with flavorful foods. For carbuncles and sores, consuming chicken meat or eggs can help push out toxins. This is superior to Ginseng; thus, treating sores should focus on dietary intake. (Xu Lingtai said: "Medicines are prescribed to treat disease, not to generate blood and qi. This seems to share the same insight.")

Exogenous diseases should be treated mainly with decoctions, while endogenous injuries should be treated mainly with food. Confusing the two leads to ineffective treatment.

Red frogs can treat not only pediatric epilepsy but also adult consumptive diseases. Epilepsy and consumptive diseases both belong to the category of *pi*. This substance treats *qi* accumulation that damages the spleen and stomach, leading to diarrhea, and also controls roundworms. (Yang's *Zhizhi* and Zeng's *Kouyi* state: "Under fifteen years old is *gan*; over fifteen is *zai*. This aligns well with this theory. However, these two scholars only used agents to consolidate yang and nourish yin, without further innovation. Gensan specifically used blood-moving and qi-stirring herbs to remove abdominal *pi*, demonstrating superior skill.")

For epilepsy with diarrhea, eating dried eel is effective.

Pressing the abdomen from the epigastrium to the umbilicus: if the Ren Mai protrudes, it is because pathological factors are gathering below the pulse. If pathological factors are not gathered, the pulse does not need to protrude. In elderly people, muscle wasting presenting with this sign indicates proximity to death.

Pressing the epigastrium along the Ren Mai: if full and forceful on both sides, it is excess; if soft, weak, and not full, it is deficiency.

In cases of extreme deficiency and exhaustion, if the lips are not pale white and the earlobes have not atrophied, recovery is possible. This requires careful observation.

When yang qi floats superficially, it is difficult to recognize signs of muscle wasting. First examine the back. If the person frequently coughs or wheezes and the back is depressed, it is due to rebellious qi manifesting as muscle wasting. This condition belongs to qi distension, hence named "deficiency floating," and is not necessarily water retention.

When examining patients, one should first inquire about a history of syphilis. Why? Because modern syphilis invades bones and joints, often blocking primordial qi.

In severe illness, if the eyes do not blink, it indicates depletion of yuan qi in the eyelids. This is "reversed eyes," a sign of impending death.

Diseases that develop gradually are often difficult to treat. Muscle wasting or water retention indicates untreatability.

Painful conditions usually present with tight or wiry pulses, similar to headache in Taiyang disease. The moving pulse and tight pulse seem opposite, but a tight-wiry pulse is an intensified form of the moving pulse. If a moving pulse changes to a slow pulse, it indicates slackening of righteous qi and persistence of pathogenic qi, as seen in chest binding with a slow pulse. Generally, a moving pulse changing to slow is salvageable; if it remains fast, it is dangerous.

Abdominal pain before the onset of jaundice often belongs to *pi*. Spleen qi stagnation causing abdominal pain can be distinguished. (*Jingui* states: "Grain qi fails to digest, causing turbidity in the stomach; this is why damp-heat causes abdominal pain." It also says: "For all jaundice with abdominal pain and vomiting, Chaihu Tang is suitable." This outlines the treatment for jaundice-related abdominal pain.)

For dysphagia where food enters suddenly, one should not eat excessively. The person's stomach is originally empty and deficient; overeating will cause harm.

Sudden stroke is often caused by *pi* blocking the heart orifice, leading to unconsciousness and death. If the heart orifice is not blocked, there may be hemiplegia or facial deviation. Even if unconscious, if the six pulses correspond and hands/feet are cold, the great qi of the body still exists, and rescue is possible.

Young men and women who are not yet fully mature but feel unwell often suffer from wind-cold and require care. If neglected for days, stool becomes loose, leading to severe illness. Therefore, constipation is good for this condition, while diarrhea is bad.

Those who make specific sounds often vomit blood, but if the pulse is not rapid, it is not frightening. True hematemesis presents with a rapid and urgent pulse, which is highly alarming.

All diseases, whether caused by the six exogenous factors, seven emotions, diet, or sexual activity, stem from the stagnation of primordial qi. Stagnation in the skin and meridians eventually affects the interior, like water flowing into lowlands. Physicians must grasp the general principle for treatment.

Syphilis stagnant in bone joints causes severe meridian blockage, leading to various complications. This must be known.

Weak individuals with chronic coughing suffer from cold qi blocking the exterior and deficient fire fanning the lungs, worsening the cough and drying the lungs.

Ben-tun syndrome may involve liver qi combined with syphilis, or liver qi with hernia. However, syphilis and hernia themselves do not constitute Ben-tun. As the ancient saying goes: "All wind, tremors, and dizziness belong to the Liver."

Conditions like spasm and fei (paralysis) involving immobility of the body will lead to death within four to five years if the patient eats well but does not exercise, as spleen qi cannot circulate. Patients should exercise to move spleen qi to fulfill their natural lifespan. Nagoya Gen'i suffered from this and managed to survive until old age through proper care, proving this point.

Severe edema and cough indicate water qi gathering in the upper body. Sudden violent cough due to water qi indicates imminent death.

Miscellaneous diseases involving hunger but inability to eat have two causes: if the person feels hungry but suddenly dislikes the smell of food, it is due to parasites; if simply hungry but unable to eat, it is due to *jia* masses.

Wei (flaccidity) and Bi (impediment) are easily confused. Bi primarily involves numbness of the skin; Wei primarily involves flaccidity of sinews and bones.

Wind pathogens are hard to cure. Recurrence after recovery does not necessarily require wind-dispelling herbs; assisting yang qi to disperse wind is key.

Yang deficiency diseases are easier to treat; yin deficiency diseases are harder. Why? Yin deficiency leads to further yang deficiency, as seen in consumption. Thus, yin deficiency with fire hyperactivity, even with good appetite, leads to death. Yang deficiency presents with non-rapid pulse and poor appetite, leading to muscle wasting. Treatment focuses on diet; moxibustion is prohibited. Moxibustion may cause the pulse to become rapid, causing harm.

In consumption with fine and rapid pulses, if the pulse suddenly appears calm, it indicates approaching death. As the *I Ching* says: "Withered poplar blooms; how can it last?" Even if slow, death occurs within five to seven days.

A man exhibited symptoms resembling madness, fearing and avoiding people, living in a dark room for half a year. Later, his spirit cleared, but he developed limb spasms, stiff tongue, difficulty speaking, hardness in the epigastrium, and distension due to *pi*. He was treated with moxibustion on the spine and bear gallbladder, and improved significantly. This condition involves *pi* obstructing distension, preventing madness. If *pi* attacked internally, mental function would fail, causing madness. Since this did not happen, he avoided this complication.

Women with masses below the navel and along the Ren Mai are infertile. Wherever *pi* exists, yang qi cannot flow; thus, moxibustion to support yang qi is advisable.

Children of parents with *pi* will inherit it, similar to the transmission of syphilis or leprosy.

Syphilis entering the eyes initially causes headache.

After bleeding, if wind-cold is contracted before blood and qi recover, it often leads to consumption. Even if consumption does not develop, mixed symptoms make quick recovery difficult.

A man with existing *pi* contracted pathogenic qi, resulting in high fever, delirium, and agitation. Treatment reduced the fever, but he experienced epigastric rebellion, constipation, and extreme weakness, failing to recover for days. I diagnosed it as *pi* and advised stopping medication, focusing solely on diet. Essence and qi gradually recovered, bowel movements normalized, and he healed completely. Although qi was exhausted, constipation indicated recoverability.

Wheezing with lower body muscle wasting belongs to *pi*. When *pi* rebels upward, lower body muscle wasting is common.

Rapid pulse with disharmonious abdominal qi indicates an impending stroke; moxibustion should be applied quickly. Delay allows food stagnation and external contraction to trigger sudden stroke.

Syphilis with rapid pulse and cough resembles consumption, but syphilis lacks muscle wasting, features constipation, and painful urination. Consumption may have turbid urine without pain, plus muscle wasting or diarrhea. Syphilis with diarrhea near the end of the disease is a ominous sign. (Note: *Meili Xinshu* suggests Gualou Tang for syphilis cough resembling consumption.)

At the point of death, various diseases often show Jueyin syndrome patterns; this is inevitable, not limited to Shanghan.

Fire hyperactivity without asthma indicates failure of the lower origin, making it difficult to save.

Severe asthma may respond to Xiangxiaomu and Chenxiang. Zhang Zhongjing used Houpo and Xingzi exclusively, suitable for those without *pi*. In modern times, most cases involve *pi*, so Chenxiang and Muxiang are effective. I formulated a prescription: Poria, Immature Bitter Orange, Pinellia, Dried Ginger, and Costus root (5 ingredients).

Yu syndrome resembles consumption. Consumption presents with faint, fine, rapid pulses; Yu syndrome presents with deep pulses, or other pulses but never faint/fine. This distinguishes them.

Extreme consumption may present with passing roundworms or intestinal mucus, indicating imminent death. Chronic emaciation with vomiting/passing worms also indicates imminent death. This applies beyond consumption; the Jueyin discussions in Master Zhong's work hold significance.

White rashes in consumption appear mostly on the chest and diaphragm, not the face, due to heat steaming and fluid leakage. This mechanism is similar to critical sweating due to衰竭 of primordial qi and loss of defensive qi, both being ominous signs. White rashes in Shanghan indicate pathogen exiting through pores, a good sign. However, judgment should be made considering other symptoms.

Water retention results from yang qi stagnating in the middle jiao, causing disharmony between upper and lower, leading to irritability and thirst, as seen in Wuling San syndrome.

Madness treated internally with Baihu Tang and externally with moxibustion utilizes Baihu to clear gastrointestinal heat and moxibustion to disperse nutritive-defensive stagnation. This combines cold and heat therapies, attacking internally and externally. (Moxibustion on Xinshu, Hunmen, and Zusanli with thousands of moxa cones is effective. *Bianque Xinshu* records a case of five-year wind-madness cured by Shuisheng San, moxibustion on Juque and Xinshu, and Zhenxin Dan. The patient required a severe flare-up to heal, confirming this approach.)

Syphilis blocking meridians can be expelled during malaria or dysentery episodes by driving out pathogenic qi, removing old toxins. The same applies to other chronic diseases.

Pregnancy is easily confused with blood masses. Blood masses are stubborn and settled, lacking expansion. Pregnancy is condensed and warm, with a moist quality. Also, if a woman's lower abdomen protrudes suddenly after sleeping at night, she is pregnant. Dark nipples also indicate pregnancy. (Amenorrhea often involves dark nipples, making diagnosis difficult. Hechuan's *Chanlun Yi* provides detailed explanations for reference.)

Later generations mistakenly believed Huangqi and Ginseng trap pathogens. Today, Huangqi is used specifically for carbuncles and smallpox toxins to draw toxins from inside to outside. Ginseng acts similarly. (Ancient formulas used Huangqi to express the exterior, not to tonify qi; Ginseng nourishes fluids. Thus, using them in Chaihu Xiexin Tang is acceptable.)

Our nation's people are strong-willed and dislike sweet tastes. Forcing sweet foods causes stagnation. Westerners are gentle and prefer sweet tastes, so herbal formulas contain more Licorice than ours. For patients, excessive Ginseng does not cause stagnation in the weak but causes oppression in the robust. Formerly, Yixi understood this, advocating qi smoothing with Xiangsu San, avoiding Licorice except for tiny amounts. (Xiangchuan Xiude's theory of qi smoothing. The world considers Gensan the originator, but he actually followed Yixi. Due to long peace, heroic qi became weak, leading to the theory of smoothing qi. All diseases root in qi.)

Methods for conception focus on warming the waist. Moxibustion on Yaoyan points and hot spring baths are effective.

Women with blood masses may have difficulty delivering even if pregnant. (Zhuoxuan noted: Narrow pelvic bones hinder delivery; surgery is required. This must be known.)

A woman had abdominal pain 1 cun above the navel, tender to touch, with a rapid pulse. Diagnosed as internal abscess. Treated with egg yolks and Huangqi/Yiyi decoction. Ten days later, pus and blood passed in stool.

Summerheat causes spontaneous sweating, making exterior syndromes rare. Do not use sweating agents; Baihu Tang type formulas are suitable.

Madness is harder to treat in women; syphilis is easier to treat in women. (Madness due to blood stasis is easier in women; even mild madness is hard to treat in men.)

Siling San plus Cangzhu is effective for night blindness. Night blindness often belongs to *gan*; since this herb is used in *gan* treatments, it works. (Zhuoxuan noted: *Yanke Tiyao* states adding Chukucao to Siling San + Cangzhu is very effective for late-onset blindness.)

Jicai treats syphilitic bone/joint pain, but its foul odor limits dosage.

I often emphasize "small heart, big courage" as crucial for physicians. (Mr.'s art innovated upon predecessors but rooted in classic texts and Sun Simiao's works. Thus, he handled major diseases with ease.) (Zhuoxuan said: "Reading this confirms his reputation is well-deserved.")

Coptis is dry; even soaked, it remains dry. Scutellaria is moist; even drained, it remains wet. Thus, although used together for dysentery, they differ in nature. This applies to treating vomiting as well.

Internal attacks of sores causing water retention are treated with Chixiaodou Tang. Severe heat responds to Dalianqiao Tang.

Hyperactive Xu Li (vital gate) often accompanies seminal emission. (Chen Xiuyuan used Longdan Xiegan Tang for nocturnal emission due to liver excess and fire. Shen Qianlü suggested treating heart fire first with Huanglian Qingxin Yin, complementing this view.)

After severe illness, weak exterior qi makes one susceptible to sudden syncope from wind-cold, even in summer. This is interior cold. (Li Ting noted: Interior cold occurs in winter and summer alike. This is profound. Zhuoxuan added: Similar to ancient views on Huoluan occurring in all seasons. These theories illuminate each other.)

Malaria and dysentery share causes but differ in location. Malaria pathogens are between exterior and interior; dysentery pathogens attach to intestines/stomach. Thus, malaria (exterior) is easier to treat; dysentery (interior) is harder to resolve. (*Yishuo* states: Summer toxin in spleen, dampness in legs; no diarrhea means dysentery, no dysentery means malaria. Gensan elucidated this principle.)

Anorexic dysentery involves severe toxins steaming from intestines to stomach. Rapid purgation with Chengqi Tang is appropriate. If purgation is missed and abdomen is soft with locked jaw, Dushen Tang is suitable.

Ge, Ye, and Fanwei are similar diseases. Fanwei involves stomach disharmony, difficult digestion, or morning food evening vomiting. Ge and Ye involve atrophic, dry esophagus, inability of grain qi to descend, or *pi* blocking the stomach entrance, hindering food intake. Fanwei often affects young adults; Ge and Ye often affect those with recurrent throat bi. Throat bi damages airways and fluids, leading to Ge/Ye. Treatable in youth; difficult in elderly due to weak stomach qi and hardened esophagus, like a leather bag shrunk by fire/water.

Ge/Ye and Drum Distension share causes related to *pi*. *Pi* obstructing beams causes abdominal distension (Drum); *pi* hiding causes abdominal depression (Ge/Ye). Both involve declining essence/qi and lack of moisture in the interior.

Long-term illness with sudden reduction of facial swelling indicates sinking of yang qi; do not ignore this.

Qi and blood coagulation generating interior heat, slowly consuming grain qi leading to emaciation, is named Laozhai. This affects not just the weak but also the robust.

Urgent breathing due to Ben-tun involves *pi* invading heart/lungs. (San Yin Xiben Tang treats this.)

Asthma sufferers, even with severe symptoms, often survive. However, sudden cessation of cough with persistent asthma in acute/exogenous diseases indicates unpredictable changes; do not neglect.

Chronic headaches often belong to *pi*, especially migraines. Right-sided *pi* causes right pain; left-sided causes left pain.

A woman from Tanbo had intractable lower back pain for three years; eating dried salted fish was effective. (Likely blood-stasis back pain. Hanaoka Seishu used dried fish powder for wei syndrome; worth trying.)

Gout and Hong Kong Foot (podagra) share causes. Gout pathogens are shallow; Hong Kong Foot pathogens are deep, affecting healing speed.

Modern Hong Kong Foot corresponds to Wind-Toxic Hong Kong Foot in *Qianjin* and *Waitai*. Song-Yuan era Hong Kong Foot corresponds to modern hernia. (Hou Teng Hui noted: Wind-toxic Hong Kong Foot disappeared in our country, revived post-Horeki era, explaining my father's statement.)

Stroke hemiplegia is often caused by *pi* blocking meridians, preventing qi extension. Right *pi* causes right paralysis; left *pi* causes left paralysis.

Facial deviation in stroke results from struggle between righteous and pathogenic qi, causing blood/qi imbalance. Deviation to the right implies pathology on the left, and vice versa. Same logic applies to hemiplegia.