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Physicians must integrate and comprehend medical texts to establish correct insights; they must study and evaluate classical prescriptions (Jingfang) to refine their clinical skills; and they must treat a wide variety of diseases to achieve mastery in application. Therefore, those who do not understand the principles of medical classics and classical prescriptions, even if highly skilled and occasionally successful, are not worthy of observation. Those who understand these principles, even when using only a spoonful or half a dose of medicine, will adhere to proper rules.

Mr. Tei, being a son of a renowned physician and possessing comprehensive academic attainment, transcended the leading figures of his generation. The ancients said, "Read Zhang Zhongjing's books, use Zhang Zhongjing's methods," yet one does not rigidly stick to his formulas but rather grasps his spirit. Is this not true?

During the transition from summer to autumn in the Bingzi year of the Bunka era, a great epidemic broke out in Edo. The initial symptoms featured rampant heat that directly entered the Shaoyang syndrome (disease pattern caused by pathogenic factors affecting the Shaoyang meridian), leading to mental confusion shortly thereafter. Generally, Xiao Chaihu Tang (Minor Bupleurum Decoction) or Da Chaihu Tang (Major Bupleurum Decoction), along with Huanglian Jiedu Tang (Coptis Decoction for Detoxification), were appropriate. Cases progressing to Yangming Fu-organ excess (Yangming bowel accumulation syndrome) were rare. Subsequent epidemics followed similar patterns, while Yin syndromes (disease patterns characterized by cold signs) were very scarce.

I once observed that my predecessor taught treating Taiyang disease (Taiyang meridian disease) with Ginseng and Aconite (Renshen, Fuzi). Elders also stated that Mr. Tei often treated patients with Yin syndromes accompanied by restlessness. Alas, this is likely due to changes in environmental and social conditions. (Epidemics vary according to annual climatic cycles, as seen in Kudo Shuan's *Juwun Shuryaku* and Ogino Taichu's *Onsen Ron*. Analyzing the rotation of the Six Qi, the entry and exit of Shen-Qi, the subtleties of Yin-Yang waxing and waning, and the variations of deficiency and excess transformation, only Zhang Zhongjing's writings achieve such coherence from start to finish. Later students should analyze this carefully.)

In the Xinsi year, spring was dry, and by late summer and autumn, the heat was extreme. Epidemic pathogens spread widely. Symptoms included aversion to cold absent, skin burning hot, pulse rapid and surging or tight and fine, trembling of the wrists, diarrhea four to five times daily or excessive loose stools, thirst preferring cold water, dry tongue without coating, epigastric fullness and binding, abdominal distension with borborygmus, delirium (mental confusion with incoherent speech), lethargy with inability to speak, foaming at the mouth and sweating on the head. Severe cases involved vomiting and upward counterflow of qi, rapid emaciation, melena (black bloody stools), and death. I believed this was caused by summer-heat invading muscles and pathogens adhering to sinews, leading to dried-up body fluids and chaotic boiling of blood. Thus, bleeding occurred as an extreme symptom. Treatment combining clearing, moistening, and tonifying, along with promoting urination, proved effective. Compared to the Bingzi epidemic, the symptomatology differed slightly.

For mild Shaoyin disease (Shaoyin meridian disease), there is a distinction between Jiji Tang (Ji Ji Decoction) and Jiangfu Yiqi Tang (Ginger and Aconite Qi-Supplementing Decoction). When upper jiao (upper burner) body fluids are dried up, symptoms resemble Baihu Tang (White Tiger Decoction) but with a floating, rapid, rootless pulse, weakness in the legs and abdomen, slight diarrhea, and thirst without the urge to drink several liters of water, Jiji Tang is indicated. If pathogens act slowly, gradually causing delirium and irritability, with mild muscle heat, a moist tongue, and a history of fatigue-induced cold contraction, Jiangfu Yiqi Tang is indicated. This pattern was common thirty years ago but is now rarely seen, replaced by patterns treated with Daochi Geban Tang (Guide Out Redness Half-Dose Decoction) and Shengyang Sanhuo Tang (Raise Yang and Disperse Fire Decoction). This reflects changes in the times.

In winter, after sweating fails to resolve Taiyang disease, frequent diarrhea occurs, or no diarrhea occurs. After three to four days, heat intensifies, accompanied by delirium, oppression, dry mouth and tongue, shortness of breath, wiry-choppy or slippery-rapid rootless pulse, yellow-moist tongue coating, epigastric stuffiness, lower abdominal weakness, red face, and deafness. I initially considered this direct invasion of the central organs and prescribed Aconite formulas without effect. Later, recognizing upper heat and lower cold, Ganjiang Qinlian Renshen Tang (Dried Ginger, Scutellaria, Coptis, and Ginseng Decoction) was used with immediate and profound effect.

From mid-summer to mid-autumn in the Jimbo year of the Bunsei era, dysentery raged in the capital, claiming countless lives. All cases were heat-toxin dysentery with fierce pathogens, involving over a hundred episodes of diarrhea. Treatment involved releasing the exterior and purging the interior, or using cooling methods. Occasionally, deficiency-cold patterns required Taohua Tang (Peach Blossom Decoction); misusing Poppy Shell (Mihu) or Chebula (Hezi) would be harmful. For weak patients suffering repeated diarrhea with bloody watery stools and severe debility, accompanied by abdominal cramping and night-time dry thirst, Rehmannia (Dihuang) proved effective.

Chronic dysentery unresponsive to treatment presents with millet-grain-like papillae on the tongue, colored yellow-white or pure red, potentially spreading to the gums; this is generally incurable. Another presentation involves thick yellow-white coating resembling thrush on the tongue, throat, and gums, accompanied by hiccups; this is also incurable. (Note: Chronic dysentery with oral thrush indicates failure of Stomach Qi and is a death sign.)

Dysentery with thirst often prefers hot drinks; it cannot be uniformly classified as Yin-cold, though cold-purgative formulas sometimes work. Dysentery with cold fingers indicates heat, with Yang Qi escaping upwards. In severe heat-dysentery where purgatives were neglected leading to extreme deficiency, cold may extend from fingers to shoulders, with feet cold only above the ankles; warming herbs are contraindicated.

Early-stage dysentery with irregular rapid pulse, frequent diarrhea, mental unrest, sweating on the forehead, and facial wasting is incurable.

During the spring-summer transition in the Genshin year of the Bunsei era, after days of rain followed by sudden muggy heat, people developed strange illnesses resembling Gan Huoluan (Dry Cholera): sudden heart and abdominal pain, violent heat, surging-large pulse, epigastric binding, inability to eat, and constipation. Prescribing Beiji Yuan (Emergency Pill) or Daxiexiong Tang (Major Chest-Sinking Decoction) worsened pain and heat, causing irritability and thirst. I attributed this to internal damp-heat stagnation attacking upwards. Using Zengsun Lizhong Wan Formula (Modified Center-Sustaining Pill, replacing Atractodis Rhizoma with Cyathulae Radix) reduced pain immediately, leading to recovery and saving several lives. Dongguo's *Daoshui Suoyan* mentions similar cases in the capital treated successfully with Mulberry Root Bark (Sangbaipi) and Evodia (Wuzhuyu), known as Jiangqi Tang (Descending Qi Decoction).

For suspected smallpox/rubella fever, palpating the Xu Li (defensive pulse area near the heart apex): vigorous movement extending to the Key Lou (supraclavicular fossa) indicates smallpox; absence indicates other diseases. I learned this secret from Ogawa Shosai and verified its accuracy.

Plague toxins, though categorized into four types, fall into two main categories: Chancre (Xigan) affects muscles with shallow toxin, manifesting as Syphilis sores (Yangmei Chuang); Bubonic plague (Biandu) affects sinews with deep toxin, manifesting as hidden toxic nodules. However, deficiency/excess distinctions apply: in deficient chancre patients, toxin penetrates easily, delaying healing; in robust bubo patients, toxin pushes outward, accelerating healing. Ultimately, it remains within these two categories.

Sudden exacerbation of chronic illness is often due to latent pathogens. Recognizing the pattern and treating with dispersing formulas, regardless of the original disease, is effective—this aligns with the principle of treating acute conditions first.

Wada Togo used Rehmannia (Dihuang) for epigastric stuffiness, based on Wu's Shenfu Yangrong Tang for post-purgation stuffiness. I believe Dihuang-related stuffiness differs from Xiexin Tang (Drain the Epigastrium Decoction) stuffiness. Abdominal tendon tension and dried fluids pressing upward cause the stuffiness; Dihuang moistens sinews to resolve it. If fluid retention binds with heat causing epigastric fullness, Xiexin Tang is required. They are similar yet distinct.

Physicians often label complex, indescribable patterns as "Xi Zheng" (Seizure Disorder), following Kagawa Gyoku. *Senkyo Ron* states Xi is a pediatric term; adults should be called Dian (Mania). Kagawa's Xi resembles Qi Ji (Qi Disorder) from *Dabing Qilun* or Xin Feng (Heart Wind) from Dai Fuan. I traced the etiology to Heart, Liver, and Gallbladder. Causes include Heart Spirit deficiency/restlessness or Liver Qi depression/excess. Gallbladder patterns vary by deficiency/excess. Studying ancient texts on these three organs clarifies more than half the treatment principles.

Differentiating cold/heat by urine color alone is difficult, as Dai Fuan noted. Determining Yin/Yang by thirst preference is also unreliable. Heat-dysentery patients may prefer hot drinks; wind-damp patients may desire cold drinks, following the principle of "like seeking like." Assuming disease nature solely based on temperature preference is generally inaccurate.

For severe Taiyang heat patterns, Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix) require large doses to be effective. For massive edema due to water qi, heavy doses of diuretics (Dan Shen herbs) are necessary, which has been repeatedly verified.

For intractable vomiting unresponsive to various treatments, HT Wehe diagnosed a floating-rapid pulse indicating exterior pathogen obstruction and prescribed Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction) for rapid cure. Another case with similar symptoms had a sunken-hidden pulse indicating constrained heat, treated with Baihu Tang (White Tiger Decoction) effectively. Both diagnoses, differing in exterior/interior location, were brilliant.

The efficacy of ancient formulas is miraculous. Examples include: Musse Zeixie San (Oyster and Alisma Powder, optionally with Rhubarb) for solid edema; Gualou Qumai Wan (Trichosanthes and Spermacoce Pill) for Shengqi Wan patterns where Rehmannia is contraindicated; Huanglian Tang (Coptis Decoction) for persistent cholera-vomiting/diarrhea with epigastric pain; Zhizi Gancao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) for dysphagia; Linggui Gan Zao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) for chronic scrotal swelling with epigastric pain; Baitouweng Tang (Pulsatilla Decoction) for intestinal wind bleeding. My years of experience confirm their efficacy like drumbeats. Mastery of ancient formulas is essential. (Chen Xiuyuan notes: Xuanfu Daizhe Shi Tang (Inula, Oyster Shell, and Hematite Decoction) is effective for intractable vomiting/hiccups due to its heavy descending nature. Ganjiang Huanglian Huangqin Tang (Dried Ginger, Coptis, and Scutellaria Decoction) works for immediate vomiting after eating. Ma Xing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) treats summerheat headache/sweating/panting/thirst. Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) treats restlessness/insomnia. Mahuang Dou Tang (Ephedra and Bean Decoction) nourishes Yin and promotes urination. These show the dragon-like variability of Jingfang.)

While many formulas treat scrotal issues, Linggui Gan Zao Tang is unparalleled. I also achieved remarkable results using San Yin Fang Bupi San (Three Causes Spleen-Supplementing Powder) refined with honey. For constipation with internal excess, Qifei Wan (Restore Decline Pill) is excellent.

In *Qianjin* Zisuzi Tang, Angelica (Danggui) is used for descending Qi, as recorded in Materia Medica ("treats cough and rebellious Qi"). In Renshen Baidu San (Ginseng Detoxication Powder), Zhiqiao (Aurantii Fructus) is used to expel wind, as recorded ("treats wind-itch and channel bi"). Physicians use these daily without examining their specific effects—a pity.

I treated a man with unresolved Taiyang disease, delirium, red face, tight-powerless pulse, slight diarrhea, and upper heat/lower cold. Jiangqinlianshen Tang failed. Kobayashi Yusai (disciple of Yoshitsugu Minamiwa) cured him rapidly with Danggui Sini Tang (Angelica Decoction for Cold Extremities), noting his own past success with this formula under Shibata Un'an.

Patients with warm toe nails but cold calves often die. Those with leg edema but no water qi in the shins, presenting only with dorsal foot swelling, are also critical.

Sudden flaccidity of chin tendons resembling "falling frame wind" is incurable. *Heji Jufang* Wujing Yuan treats "loose jaw unable to close, hand supports jaw to eat," which belongs to this category.

Hiccups unresponsive to treatment respond to Bear Gallbladder (Xiongdan) or Zuojin Wan Formula (Left Metal Pill).

Hongxiangjiao (Beriberi/Water Swelling) with smooth urination but chest pulsation, even ascending to the heart, indicates external water toxin invading internally. Even with stable pulses and no urination, ascending to the heart indicates internal water toxin obstructing pulse movement. These two variations require careful thought.

Hongxiangjiao without lower edema but with swelling in chest, back, neck, face, or hands, suddenly ascending to the heart, is serious. Similar to severe upper edema.

Hongxiangjiao with vomiting, hiccups, and panting signals impending heart involvement. However, look-alikes exist. One strong man with weak swollen calves, panting, shortness of breath, and intense heat was diagnosed with epidemic pathogen phlegm; Chaihu Xianxiong Tang (Bupleurum and Chest-Sinking Decoction) plus diuretics cured him quickly. Another with paralysis, weakness, vomiting, and anorexia was diagnosed with Hongxiangjiao plus roundworms; Shengqi Wan Formula (Kidney Qi Pill) plus Wumei Wan (Mume Pill) cured him completely. Diagnosis relies on pulse and chest pulsation; only experts can discuss this. (I heard Mr. Tei cured Hongxiangjiao hiccups/heart-ascending with single-ingredient Forsythia Paste, achieving ancient secrets.)

Hongxiangjiao fever resembling wind-cold, if not ascending to the heart, leads to leg weakness, which is frightening. Treating specifically for Hongxiangjiao is wise. True wind-cold cases differ and require differentiation.

Two subtle diagnostic challenges: First, consumption/Liver Qi stagnation starting with external pathogens; even after external resolution, internal pathology prevents cure. Treating only as external contraction fails. Second, new ambiguous symptoms in chronic illness patients (e.g., intestinal issues in mass disorders, dietary injury in scrotal disorders). Clinging to old diagnoses while ignoring new ones is dangerous. These require precise diagnosis. Zhang Jingyue said: "A wise doctor's mind is outside the box; a wise doctor's eyes see before signs appear." This applies here.

Disease names vary across eras, causing confusion. Examples: "Zhong" originally meant abscess, now edema; "Chuang" originally meant wound, now sores; "Gan" originally meant erosion, now pediatric malnutrition; "Gantan" (Tan Yin) originally clear fluid, now thick saliva; "Dan" means heat, abbreviated to "Dan" (jaundice), then erysipelas; "Liu" means hanging growth, now erysipelas; "Ji" means heart beating, now pounding sensation; "Ben Tun" is Kidney Accumulation in *Nanjing*, Qi Rush in *Shanghan Lun*; "Ke Ni" is cough/wheeze, mistakenly called hiccup in later times. These must be distinguished. (Mr. Keiyama's preface to *Onsen Ruben* clarifies these well; consult it.)

Recent medical books by Hakusai merely repeat old words without innovation, with flattering prefaces written by those who don't read classics. This is mere imitation, chasing fame and profit.

Reading medical classics differs from other books. Reading *Shanghan Lun* requires humility and calmness, focusing on its simplicity to study life principles, ensuring text matches practice. Then, cross-reference sources and verify clinically. Only through long-term accumulation can one handle infinite variations. This is reading well. Others who force interpretations, hold prejudices, boast superficial insights, debate without clinical focus, or obsess over philology miss the point. Ignorant speculators claiming to grasp classics while dismissing contradictions as later interpolations are like "summer insects doubting ice" or "Yue dogs barking at snow." While classics explain pathology, clinical verification also reveals meaning. (Valuing learning and mentorship helps compare treatments with classics, another way to understand them.)

Commentaries by Cheng Lianshe are straightforward but shallow. Fang Zhongxing innovated but arbitrarily rearranged text. Yu Jiayan followed Fang, confusing later generations. Ke Yunbo was knowledgeable but speculative. Cheng Jiaoqian used colloquialisms but offered precise logic. Wang Lingyou smoothed previous notes but retained flaws. Zhang Yinan and Ling Shao stuck to old texts without alteration. Qian Tianlai debated tirelessly but was sometimes too rigid. *Yizong Jinjian* compiled much but altered chapters/sentences excessively. (Duji Liu noted: Ancient commentaries avoided literalism. Ke Yunbo's *Laisu Ji* opened new paths despite structural changes. Qian Tianlai's *Suyuan Ji* organized chaos for clinical use. Both are precise but verbose. Zai Jing's book derives from Ke, structures like Qian, offers fresh insights concisely. Their balanced views serve as models for students, alongside Lu Cangzhou's historical essays.)

Reading should follow ancients. Once their words are sound, no need for redundancy. Arguing for show or forcing connections is useless.

If textual evidence is solid, cite it simply; verbosity is unnecessary.

Precise philology is useless if it doesn't aid treatment. Imprecise philology yielding clinical results captures the classic's essence.

Theories must cover the whole classic to be complete. Rigidly sticking to norms without flexibility is poor reading. Studying Huangdi, Qibo, and Changsha classics, selecting good masters' works for clinical application, is our family's method. My father collected books for us to read and apply well. (These lines open the right path for students. Medical literature is vast; biased views are numerous. Focus on key classics, study deeply, and progress naturally. Ignore trivial details; why check every anomaly?)