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Note: Those who transmitted Mr. Gensan's medical skills at that time included Shukoku Kagawa and Shoutoku Yamawaki in the capital (Kyoto), Matase Mutsu in Naniwa (Osaka), Shigetaka Yamasaka in Ise, and Teisen Akazawa in Bizen. Family transmissions were numerous. Among those who later privately revered him as their teacher, Kamei Ro of Chikzen was the most prominent. He wrote *Byoin Bikou* (Supplementary Examination of Disease Causes) to supplement and support his theories. He also composed a poem: "The Grand Administrator of Changsha was originally a Confucian scholar, expounding ancient methods and medicine to benefit generations for a hundred years. Pointing directly to the classic prescriptions returns to simplicity; whose private theories are so dogmatic? Why trouble with voluminous books on the pivot mechanisms? One should be ashamed of understanding only the dregs, like Liu Lun [a metaphor for superficial understanding]. Lofty is Old Man Gensan Fuji, whose talent, virtue, and benevolent art are worthy of closeness."

Yumatsu had an open and free spirit. With extraordinary talent, he inherited the transmission of Fujian doctors and excelled in mastering methods beyond the conventional rules. Thus, his therapeutic techniques opened new paths, possessing profound spiritual insight and the miraculous ability to bring spring to his touch.

Yumatsu was skilled in translation (Xiangshu studies) and studied the profound principles of Zhang Zhongjing from the Zen monk Karyin. From Dai Manso, he obtained the essence of *Huangdi Neijing* (Yellow Emperor's Inner Canon) and Materia Medica. Later, believing that the medical customs of his own country (Japan) should also be studied, he took the small-courier doctor Harasan (a senior disciple of Okamoto Genchi Takatomo) as his teacher, ultimately achieving great success in his field.

In cases of deficiency consumption (Xu Lao) presenting with rectal pain, difficulty in defecation, or hemorrhoidal fistulas, these are all due to damage to the lungs and large intestine, making them difficult to treat. (I have frequently diagnosed deficiency consumption patients, finding this syndrome common, yet rarely curable. The ancients said the lungs and large intestine are exteriorly-interiorly related; this reasoning may be correct.) For blood-astringing herbs, using Cinnamon Twig Decoction (Guizhi Tang - *Note: Text says Mudanpi, Jingjie, Puhuang fried black*, correcting to specific herbs mentioned: Radix Paeoniae Rubra (Mudanpi), Schizonepeta Herb (Jingjie), and Sparganium Rhizome (Puhuang) fried until charred is considered unique. (This aligns with the practice in our country where women's medicines are often fried black for use, deriving from this idea.)

A man in Osaka around fifty years old was depressed, avoided people, had reduced appetite, and resembled tuberculosis (Lao Zhai). Initially treated with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), then cured by Jiu Wei Qing Pi Tang (Nine-Ingredient Spleen-Clearing Decoction) added with Yu Zhu (Polygonatum Odoratum Rhizome). For opening liver and spleen stagnation, nothing surpasses Qing Pi Tang. When encountering liver-spleen stagnation, recognizing this decoction as the primary treatment is crucial.

A woman who had not spoken for three years, speaking only one or two words within a month, was considered a case of Tuo Ying (Depletion of Camp Qi). She was given Ren Shen Yang Rong Tang (Ginseng and Nutritive-Qi Tonifying Decoction) and recovered along with lifestyle adjustments (changing clothes/seasonal care).

For persistent night sweats, Jiu Wei Qing Pi Tang added with Gu Pi (Cortex Lycii) and Bie Jia (Carapax et Plastrum Testudinis) yields miraculous effects. Dang Gui Liu Huang Tang (Danggui Six-Yellow Decoction) added with Gu Pi, Fang Feng (Saposhnikovia Root), Gui Zhi (Ramulus Cinnamomi), Hei Jiang (Charred Ginger), and Jiao Mu (Fructus Piperis Kadsurae) is also effective. Jiao Mu can astringe sweat; the ancients discussed this, though I have forgotten the source. (Kagawa Shukoku's *Yakusen* discusses the efficacy of Jiao Mu in detail; reference is advisable.)

A man suffered from a disease resembling Ge Ye (Diaphragmatic Dysphagia). Yumatsu diagnosed it as insufficiency of heart, spleen, and kidney qi, causing a lack of moisture in the chest and diaphragm, preventing food and drink from going down. He prescribed Ba Wei Wan (Eight-Ingredient Pill) formula added with Gua Lou Ren (Semen Trichosanthis), Bei Mu (Fritillariae Bulbus), Chen Pi (Pericarpium Citri Reticulatae), and Suo Sha (Fructus Amomi Rotundus), concurrently using Jin Gui Da Ban Xia Tang (Major Pinellia Decoction from the Golden Cabinet). (Ren Shen dosage 0.5 to 1 qian; often combined with Shen Fu Tang.)

For chronic headache caused by syphilis that does not heal, drinking decoction made from Pomegranate Peel (Zhe Liu Pi) wine suddenly improves it. This is because previous doctors mistakenly used wind-dispersing herbs to induce sweating; thus, the astringent nature of Pomegranate Peel heals it. Xian Xing Zhai's Divine Formula for Head Wind is also effective. (Tu Fu Ling 4 liang, Jin Yin Hua 3 qian, Man Jing Zi 1 qian, Xuan Shen 8 fen, Fang Feng 1 qian, Tian Ma 1 qian, Xin Yi Hua 5 fen, Hei Dou 49 grains, Deng Xin Cao 20 roots, Ya Cha 5 qian. Decoct with half a bell each of river water and well water, take one bell.)

A student had a protrusion near the Shangwan point below the chest, accompanied by shortness of breath and irritability. Yi Xiao San (Miraculous Effect Powder) added with Jiao Mu cured him. For eye sores (commonly known as Nu Bo Jin Gu or Nu Bao), Sheng Ma Ge Gen Tang (Bupleurum and Kudzu Root Decoction) added with Jiao Mu is effective.

Yumatsu treated extreme emaciation (Xu Lei) using Yang Rong Tang or Zuo Gui Wan (Left Restoring Pill) formula, specifically adjusting based on the amount of blood color in the ten fingernails. Distinguishing good or bad blood color lies in the nails, which must not be ignored. (Old doctors' tradition says: After checking the pulse, press the patient's nails. If they turn white upon pressing and red upon release, it is auspicious; even long-term illness is treatable. If they turn red but do not recover color, even acute severe illness is ominous. Kagawa Shukoku's medical remarks also record nail-differentiation methods for examination.)

For vomiting, dysphagia, and inability to eat, Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) added with Hai Fu Shi (Lapis Aquamarina) and Ku Fan (Alumen Calcination) is effective.

Breast swelling belonging to qi stagnation and blocked lactation are effectively treated with Si Wu Tang (Four-Substance Decoction) added with Wang Bu Liu Xing (Vaccariae Semen) and Chuan Shan Jia (Scaly Pangolin Scale).

For debilitating syphilis, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the main prescription, with modifications based on symptoms showing many verifications. (Note: In *Yi Gang*, Xiao Chai Hu Tang added with Cao Long Dan, Huang Lian, and Hu Huang Lian treats chronic chancres. For sudden headache, fever, and spontaneous sweating, the summary version removes Da Zao and Sheng Jiang, adding Zhi Zi, Long Dan Cao, Dang Gui, and Shao Yao. It treats heat-toxin descending in the liver meridian, buboes, swelling and pain, all sores and ulcers, or wind-toxin nodules and scrofula; many such cases exist,宜考. Wada Toaku said: For syphilis with heat, if the heat is not resolved first, it will not heal; this is the purport of using Xiao Chai Hu Tang.)

Master Tosa (Chosawa Michitoshi) lived in seclusion in the Western Mountains. One day, diagnosing a Kyoto merchant's carbuncle and abscess, he said: "You should take 5 qian of Ren Shen daily." Five days later, he said: "I see no effect from the Ginseng; I fear it is incurable." The family admitted: "He takes only 2.5 qian per day." The Master said: "Disregarding life for wealth is useless. If you wish to live, take Ginseng: 5 qian today, 6 qian tomorrow, 7 qian the next day, gradually increasing. The merchant followed this advice, and the disease healed in seven days. Yumatsu said: Using Ginseng with proper regulation truly grasps the secret of tonification and expulsion."

Master Tosa wrote *Yifang Koujue Ji* (Collection of Key Formulas) in three days. Arima Ryori possessed a handwritten complete copy of *Zhengzhi Zhunsheng* (Standardized Diagnosis and Treatment), memorizing its insights; his dedication is equally commendable.

For treating headaches, Bo He (Menthae Haplocalycis Herba), Shi Chang Pu (Rhizoma Acori Tatarinowii), Ge Fen (Radix Puerariae), Chuan Xiong (Ligustici Chuanxiong Rhizoma), and Bai Zhi (Angelicae Dahuricae Radix), ground finely and taken with refined honey, is effective. It is especially wonderful for chronic head wind.

Za Zhuo Hua Tan Wan (Miscellaneous Writing Phlegm-Resolving Pill), shaped like a white broad bean, is excellent for resolving phlegm. For forgetfulness caused by wind-phlegm knotting in the pericardium, it is invariably effective. A monk suffering from this after an epidemic recovered quickly after taking it.

For bleeding due to excessive use of Shi Gao (Gypsum Fibrosum), Bu Zhong Yi Qi Tang added with Rou Gui (Cinnamomi Cortex) and Gan Jiang (Zingiberis Rhizoma) is effective.

For lower body edema in women or difficulty urinating, grinding Ku Fan (Alumen Calcination) finely and applying it to Yongquan (KI 1) acupoint and fingertips promotes urination and reduces swelling.

Changes in chickenpox/variolola symptoms according to days follow the same principle as the transmission of meridians in Cold Damage; both belong to epidemic qi. Knowing the rise and fall of Yuan Qi (Primal Qi) and the intensity of pathogenic factors is key. Merely adhering to Huang Qi (Astragali Radix), Dang Gui (Angelicae Sinensis Radix), and Ren Shen throughout treatment is insufficient for discussion. (Note: Sui-Tang medical texts classified variola as epidemic; during Song-Yuan, the theory of fetal toxin arose, obscuring this logic. The master specifically elucidated it, showing outstanding insight.)

White coating on the tongue in epidemic diseases indicates heat entering the fu organs. Red, ulcerated, and dry tongue indicates heat entering the zang organs. Zhang's *She Jian* (Tongue Diagnosis) discusses this accurately.

Zhang Jingyue's formulation of Ren Shen Hu Jiao Tang (Ginseng and Pepper Decoction) has profound significance. For extremely deficient patients, Fu Zi (Aconiti Lateralis Radix Praeparata) can cause primal qi to scatter. Therefore, when using Fu Zi, the pulse may become hidden and knotted; the existence of this decoction is necessary.

A woman suffered from excessive salivation for several days. Doctors attributed it to intestinal parasites or deficiency-cold, but treatment failed. I attributed it to depression/stagnation (Yu) and gave Zheng Qi Tian Xiang Tang (Upright Qi Heavenly Fragrance Decoction), resulting in rapid recovery. (Excessive salivation lingering after an epidemic, treated rapidly by an old doctor with Da Chai Hu Tang, also belongs to stagnation.)

The differentiation between Shang Han (Cold Damage) and Lei Shang Han (Similar-to-Cold-Damage) in the *Shang Han* section of *Zhengzhi Zhunsheng* should be read and memorized thoroughly by students; let disciples copy it out.

A female physician initially treated patients with heavy doses of 7-8 qian per prescription, especially high amounts of Gan Cao (Glycyrrhizae Radix), without effect, and was considered mediocre. She said: "My fault. Our people are physically weaker than those from Tangshan (China), so standard doses do not hit the mark. I reduced the dosage and lessened the sweet taste, achieving nearly 100% success."

Seeking the root in treating disease is the model of past sages. Prescribing according to symptoms is the application for later learners. When treating four-season cold damage, following their categories, how can one be confined to limited theories! (Physicians should regard this as a guiding ideal.)

Emperor Taizu of Ming commented on Xu Da: "Engaging more with worldly affairs clarifies wisdom; enduring hardships for long makes thoughts comprehensive. My career exemplifies this." (Extending one's own desire for salvation to save others is called 'manifesting the teaching.' Indeed, an immortal argument through the ages.)

Bu Zheng Xia, courtesy name Zhengfu, never lowered his aspirations despite adversity. He once said: "A gentleman has three regrets: not learning in this life is the first regret; wasting this day is the second regret; failing this body is the third regret." I added: "Not doing good is the fourth regret; not correcting faults is the fifth regret; blaming heaven in old age is the most regrettable."

*Guykong Lun* states: "For Li Feng (Leprosy/Malignant Wind), prick the swelling with素的 (plain/unadorned) needles. Stop after pricking. Use sharp needles, pressing the area while needling to expel evil qi. Stop when swelling subsides. Eat only 'Fang Shi' (standard/appropriate food), do not eat other foods." Following these eight characters regarding 'standard food' is a wondrous secret for treating difficult diseases, not just Leprosy. Thus, I have regarded it as the standard for medicine and diet throughout my life. Note Zhang's commentary: "Eating according to method is called Fang Shi; not eating other foods means avoiding wind-moving and toxin-releasing items." This view is incorrect. 'Fang Shi' refers to habitual foods; 'other foods' refer to uncommon ones. People accustomed to rich foods find bland food repulsive; those used to coarse food find fine food damaging. Not only does this not cure the disease, it generates new ones.

Dong Yuan's *Bian Huo Lun* (Discussion on Dissolving Doubts) should be one volume. The current two volumes are likely later additions. Why? From Bu Zhong Yi Qi Tang to Summer Heat Damaging Stomach Qi, it discusses treatments for Jan-April. From Lung to Spleen-Stomach Deficiency, it discusses May-June. Down to Internal Injury differentiation, it covers Sept-Dec. It follows one theme consistently; dividing it into two volumes is obvious.

Li Dongyuan's differentiation of internal vs. external suspected syndromes is very precise. Especially the distinction between Qi Deficiency and Qi Excess benefits later learners greatly. However, for combined internal-external cases, Li's explanation is incomplete; one should study ancient texts to fill gaps.

Deficiency and damage of the lower origin, with withered essence and qi, when complicated by external wind-cold resembling warm epidemics, requires deciding whether to tonify deficiency first, expel pathogen first, or combine tonification and purgation. This is the most arduous part for physicians, beyond what ink and brush can fully describe.

*Yi Gang Mu Lu* stands alone, differing in style from other books. Qian's discussions on pediatrics form a distinct school. Relying on it is not wrong, nor is ignoring it. (Zhuoxuan said: Medical books in the Ming Dynasty were countless. Most were comparative; apart from Dai Fuan, Wu Youxing, and Chen Shigong, there are few. *Yixue Gangmu* is among the outstanding mediocrities; this remark is meaningful. Qian Zhongyang was a major figure in 'Silent Diseases' (pediatrics), but viewing his work as a single school shows true insight.)

Treating Cold Damage, knowing the 'path of departure' and 'path of arrival' is key. Whether surface to interior, Yang turning to Yin, moving positions, or staying constant. Examining this allows for over half the prescription strategy. Yu Chang discussed this; consult his works.

I often advocate practical learning to disciples: Meridian and pulse theories must be known, but rigid adherence loses practical utility. Learners must have discernment in selection.

I dislike lecturing, except on the 8th of the first lunar month honoring Shennong, where disciples lecture on *Shanggu Tianzhen Lun*. (Its saying: Listening to lectures yields little benefit compared to reciting a hundred times; understanding comes from the heart. This serves as a warning for physicians to trust ear [oral tradition] over eye [text].)

In my late years, I read Materia Medica day and night without putting it down, so my prescriptions contain no redundant herbs.

When treating monks like Nan Yuan Yue, Gao Quan, etc., I used large doses. Why? People from the Western lands have stronger guts and stomachs than our locals; light doses cannot match them. Differences in climate and constitution must be known. (Western doctors prescribe directly for patients to buy and take, ensuring appropriate dosages, unlike our local doctors who use light doses for profit.)

Gan Mai Da Zao Tang (Licorice, Wheat, and Jujube Decoction) has miraculous effects for postpartum conditions resembling possession. (Note: So-called 'as if possessed by spirits'.)

For Cold Damage with high fever, irritability, thirst, red urine, constipation for 7-8 days, dry tongue, red eyes, intermittent consciousness, and only sipping rice gruel: One doctor gave Qing Xin Wen Dan Tang removing Xiang Fu, adding Chen Sha and Dan Zhu Ye, worsening delirium and making the pulse hidden. Then, Bai Hu Tang (White Tiger Decoction) combined with Huang Lian Jie Du Tang (Coptis Detoxification Decoction) stabilized symptoms. Finally, decocting 3 qian Ren Shen and 1 qian Hei Jiang, taken together, led to complete recovery. (Note: This aligns with Wu Youxing's Chengqi Tang plus Ren Shen.)

Jian Zhong Tang stopping pain upon entry demonstrates 'sweetness relieves urgency'. Gan Cao Fen Mi Tang treating heart pain shares similar intent. Taking honey for dysphagia allowing immediate eating reflects the same principle. Da Ban Xia Tang's use of honey is merely this intent.

Zhang Zhongjing's book shines like the sun and stars, imperishable through ages; those who read it thoroughly understand its meaning. (At that time, doctors mostly read *Suwen* and *Nanjing* but not *Shanghan Lun*; thus he spoke to show it as a divine book for eternal principles and a secret manual for saving lives.)

*Neijing*'s concept of Zhong Shi can be summarized as: Hyperactivity causes harm, succession brings control. (Scripture says: Knowing the key ends in one word; not knowing it leads to infinite scattering. Truly knowing the key.)

Dong Yuan based Bu Zhong Yi Qi Tang on the *Neijing* principle that clear and pure Yang qi gathers the four extremes, deeply grasping the scriptural intent. In our country, Tosa Michitoshi studied this intent well, making him longest in treating spleen and stomach disorders.

Luo said: Cases with 70% internal injury and 30% external injury are incurable; this shows good understanding of Li's intent.

Therapeutic methods: Purging then tonifying is easy; tonifying then purging is difficult.

Danxi criticized *Ju Fang* to remedy contemporary abuses; his disciple Dai exclusively using *Ju Fang* reveals the intent.

Gurin Jianyi treated edema in a farmer from Kumano Mountain, Japan. Medicine failed for a long time. He added Qing Yu (Green Taro) to the formula and made it a daily meal, curing the disease. Because the farmer grew up in the mountains and ate this regularly. But when he went to Naniwa to seek medicine from various doctors, taboos became strict. Thus, spleen-stomach function was disrupted, and drug power could not reach. This applied the method of 'appropriate dietary therapy'.

For sore throat, cheek swelling, and vomiting/hiccups, Xiao Chai Hu Tang and Lian Qiao (Forsythiae Fructus) in equal parts are effective.

For Water Qi (Edema/Water Retention) regardless of new or old, if pulse-taking prevents raising the hand, or pressing the foot prevents extending the leg with slight panting, it is a death sign. Edema that suddenly decreases and recurs is also incurable.

For Lin Disease (Strangury), use Wu Ling San, Ping Wei San, or Liver-Purging decoctions. For severe涩痛 (astringent pain) in the urethra, Bu Zhong Yi Qi Tang added with large dose Pu Huang, Wu Ling Zhi, and Jin Yin Hua is effective. (Note: Also effective for chronic chancres noted internally.)

I often teach beginners to write ancient medical cases on scrap paper, placing formulas separately, aiming for appropriateness as the highest level.

Even if formula and syndrome correspond, if dosages are insufficient, efficacy fails. Ge Kejiu's discussion on Rhubarb dosage in trauma is very detailed. Especially for Ren Shen in sudden collapse of middle qi, or Gui Ban (Plastrum Testudinis) in yin deficiency, precise dosage is crucial.

Yumatsu treated swelling with Bu Qi Yang Xue Tang, curing 70-80%. This formula uses no diuretics, yet achieves great results in difficult swelling cases. Its intent is specifically treating distension.

A doctor read Yu Chang's *Yuyi Cao*. Yumatsu heard and said: Yu's book has benefits, but using it as a treatment model might be for inferior practitioners.

For refractory hiccups and vomiting unable to take medicine, Xuan Fu Dai Zhe Shi Tang (Inula and Hematite Decoction) is effective. The妙用 (wonderful use) lies in the combination of Ren Shen and Dai Zhe Shi. Similarly, Bai Tong Jia Zhu Dan Jiang Tang's wonder lies in Fu Zi and Pig Gallbladder bile.

An old man from Min transmitted treating dim/blind vision using Yuan Shuang (Iris Frost/Poison). This principle is lofty and worth pondering.

In Ikeda, Settsu, there was a strange disease: sore legs, muscle wasting, difficulty bending/extending, becoming paralysis, commonly called Ikeda Disease. Others contracted it from Ikeda. Yumatsu cured it with Du Shen Tang (Single Ginseng Decoction).

Ba Wei Wan is a standard formula for Zhuan Pao (Bladder Displacement), but dosage must be increased stepwise to be effective. This implies benefiting the water source; 3 to 8 qian is optimal.

Small dosage prescriptions are not always ineffective; *Yixue Zhengchuan* discusses this, and Wang Ren'an also commented.

For accumulated qi, qi stagnation, or night fevers: Some have onset and cessation. Detailing the cause, some had malaria; even years later, combining Yin Malaria Pills yields miraculous results.

Min people transmitted treating poverty-induced Xiao Ke (Wasting-Thirst) using rotten wood from water, powdered. Also treating head wind with Yuan Tou Shuang (Iris Frost) in sake. Yumatsu treated a military officer with spinning eyes using Yuan Tou Hui (Iris Ash), expanding this intent.

Whenever using tonifying and yin-nourishing herbs, if Chen Pi, Ban Xia, Mu Xiang, or Sha Ren are not included, the medicinal qi cannot penetrate. This principle must not be omitted. (Note: Ancient Huang Qi Jian Zhong Tang added Ban Xia derives from this intent.)

Formulas are methods. Like destroying an old house to build a new one, it is key to use the formula without being enslaved by it. Using a stroke formula for cough is 'using the formula'; using wind-dispersing herbs for wind and cough-suppressing herbs for cough is 'not using the formula'. Seeking the root cause and letting symptoms resolve themselves is the supreme method.

Lower body edema with Fang Ji Fu Ling Tang, upper body edema with Fu Ling Bu Xin Tang, both effective. Women's edema often belongs to blood aspect; Fang Ji enters blood aspect, hence effective. If qi aspect, Fu Ling and Ze Xie are primary. For male/female yin-deficiency edema, Liu Wei Di Huang Wan added with Fu Zi, Fang Ji, and Cang Zhu is effective. For edema with strong yuan qi, Da Cheng Qi Wan (pill form) is effective.

*Zhengzhi Yaojue* is a must-read. Adding Mu Xiang to Huo Xiang Zheng Qi San as a variation is particularly commendable. Bei Cun Daobu from Kitamura Village, Kyushu, aged sixty, suffered stroke. Kyoto doctor Jishima failed. I was invited. I diagnosed: "To heal quickly, it will recur in three years, becoming incurable. If not seeking quick healing, lifespan extends 15-16 years. Choose." Patient chose quick healing. I prescribed Yi Gong San added with Wu Yao, Bai Zhi, and Qing Pi. Fifty doses cured him. Three years later, it recurred as predicted. Disciple Yajima Ansetsu asked for slow-treatment formula. I said: Shi Quan Da Bu Tang is appropriate.

Yumatsu sat leaning on a table at Bei Cun's house. A woman came for consultation. Seeing her, he rebuked: "Your jealousy overflows your face; detest it deeply." The woman blushed and accepted. He said: "Your spirit is very diseased. If you repent, I will treat you kindly." He gave medicine, and she recovered. This woman had been jealous for years, peeping through doors at night, acting mad. Yumatsu saw through it instantly; people admired his skill.

An old doctor from Sakai asked for a resurrection formula. Answer: "No formula is magical; only seek the root. Nothing else."

For diseases hard to distinguish as deficiency/excess, or hard to decide tonify/purge: Observing pulse and syndrome, trusting the reliable pulse and syndrome, and following the certain signs ensures no error in treatment.