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By the fourth watch (1 a.m. to 3 a.m.), sounds of cracking were heard from within the coffin, indicating that the vital energy (Qi) had just ceased. His friend, Ma Hechuan, a learned scholar from Dangtu named Shouling, composed a poem for this occasion. I have summarized its gist here; unfortunately, the effective prescription used in his treatment was not obtained.

Chen Zaian, whose given name was Kun, resided at Keqiao in Shanyin County. Inheriting the medical lineage from his father, Mr. Meifeng (Cui Can), he practiced with humility and frequently saved critically ill patients. He also extensively collected books, studying them tirelessly. In the spring of the Ding-Si year of the Xianfeng era, he visited me in Wulin. We felt we had known each other too late and exchanged secret manuscripts for copying. Zaian's eldest son had suffered from throat pain for several days in his childhood, followed by whole-body skin eruptions resembling peeled skin, accompanied by unbearable pain and itching. Physicians could not identify the condition. Anxious and at a loss, Zaian suddenly recalled a record in Tang Lishan's *Wu Yi Hui Jiang* (Collected Lectures of Wu Physicians). The disease was called "Lu Dan" (a severe dermatological condition), which required application of boiled honey mixed with Cimicifugae Rhizoma (Shengma) via rubbing. If not treated immediately, death was inevitable. He immediately applied this method; the honey dissipated as it was applied. After two days and nights using several sheng (a unit of volume) of honey, the boy recovered. Such was the efficacy gained through diligent study.

Zhao Yunge, whose given name was Tai, from Hangzhou, diligently sought medical principles and thoroughly comprehended pathological mechanisms. Two of his relatives had been critically endangered due to misdiagnosis and treatment with damp-draining herbs. Zhao treated both by unblocking the water passages (promoting urination), determining that the conditions were not due to damp-heat. He prescribed Hu Zhang San (Polygonum cuspidatum Powder) augmented with Liang Tou Jian (Aconitum coreanum root) and Jiu Gen (Imperata rhizome). Their urination became unobstructed, and they recovered. In another case, a patient presented with swelling below the knee. A physician had administered Wu Ling San (Five-Ingredient Powder with Poria), causing the swelling to worsen. Zhao observed that the swollen area was very cold and the complexion was pale, diagnosing Yang deficiency. He prescribed Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet), resulting in recovery. Damp diseases are prevalent in the South, and these two cases particularly involved dampness, yet damp-draining herbs were contraindicated. This illustrates that one must not adhere rigidly to a single method in treating diseases. Only those with profound knowledge and learning can achieve such precision.

Shen Yinmei, whose given name was Bingrong, a Prefectural Judge from my county, was well-versed in medical theory. While serving in Zhili, he treated a twenty-eight-year-old woman who developed epilepsy following the death of her husband. [The text contains a gap here, but implies:] ...therefore, this medicine was used to harmonize the Heart and Kidney, extinguishing the fire so that the disease resolved spontaneously.

Physicians writing books often use fictitious claims to boast of their efficacy. For instance, Dou Cai's *Bian Que Xin Shu* (New Book of the Mind of Bian Que) claims it was bestowed by Heaven; *Zhang Jingyue Quan Shu* (Complete Works of Zhang Jingyue) claims it was received from an extraordinary person met while traveling in the eastern frontier; and Chen Yuan Gong's *Shi Shi Mi Lu* (Secret Records of the Stone Chamber) is even falsely attributed to the Heavenly Master Qi and Lei Gong, which is absurd. *Hong Shi Ji Yan Fang* (Collected Verified Prescriptions of the Hong Family), five volumes, was compiled by Hong Jingyan Zun during the Song Dynasty. Although *Ben Cao Gang Mu* (Compendium of Materia Medica) cites many Song dynasty prescriptions, it omitted this book, likely because it had been lost for a long time. During the Jiaqing era, Huang Yaopu Pieilie from Wu County obtained a Song dynasty printed edition and republished it, allowing the book to circulate. In his preface, Huang stated that after printing, he sought a preface from Du Xue Lao Ren (referring to Shi Dianzhuan Yunyu). A letter indicated: "Regarding the Jiao Gan Dan (Interacting Cinnabar Pill) mentioned yesterday, I suspect the dosage of Cyperi Rhizoma (Xiangfu) is excessively heavy. Checking my collection, the formula uses one piece of Cyperi Rhizoma paired with four liang of Poria (Fushen). Your copy lists one jin of Cyperi Rhizoma. I conjecture that one piece of Cyperi Rhizoma cannot weigh one jin; it is likely a scribe's error. If you can check the original, this is indeed prudent. However, I will verify this using the Jiang Qi Tang (Descending Qi Decoction) entries in this work: one entry uses half a jin, another uses five liang. Thus, the original prescription using one jin was not erroneous. Such were the customs of the Song Dynasty. I record this to consult experts in medical theory to correct right and wrong." I note: Dosages vary according to the roles of Sovereign, Minister, Assistant, and Courier in a formula. For example, in the Cong Rong Rong Fu Wan (Cistanche and Prepared Rehmannia Pill) in this book, Semen Cuscutae (Tusizi) is six liang, while Chensxiang (Aquilaria wood) is only one fen, showing a greater disparity than one jin versus four liang. Furthermore, *Rui Zhu Tang Jing Yan Fang* (Experienced Prescriptions of Rui Zhu Hall) also records this formula using one jin of Cyperi Rhizoma, and *Ben Cao Gang Mu* confirms this dosage under the entry for Cyperi Rhizoma. Therefore, Huang's assertion is correct.

In the self-preface of *Su Shen Nei Han Liang Fang* (Good Prescriptions of Su and Shen, Inner Scholars), Shen Cunzhong wrote: "Prescribers today often exaggerate therapeutic effects. Works like *Qian Jin Fang* (Thousand Gold Formulas) and *Zhou Hou Bei Ji Fang* (Emergency Prescriptions Behind the Elbow) contain much hyperbole, making people distrustful." Even these excellent ancient texts are subject to such criticism, let alone others. For instance, Su He Xiang Wan (Styrax Pill) and Zhi Bao Dan (Precious Cinnabar Pill) are renowned for miraculous effects, yet the book contains mostly hot herbs. Zhi Tu Ruan Hong Wan (Stop-Vomiting Soft Red Pill) uses Xin Pi (Realgar processed with vinegar and garlic) and Ba Dou (Croton seed); Zhi Jing Chen Sha Wan (Calming Fright Cinnabar Sand Pill) uses Ni Fen (Calomel) and Long Nao (Borneol). These are extremely harsh and dangerous; how can they be disregarded? Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the main formula for Shaoyang syndrome in Cold Damage. Yet this book claims it is especially effective for dysentery with red and white discharge, stating that dysentery is often caused by latent summerheat, and this formula resolves summerheat toxicity well. It suggests that for any heatstroke victim, regardless of symptoms, repeated doses will resolve the condition. This attempts to apply one formula to all summerheat patterns, potentially repeating the disaster caused by Sheng San Zi (Holy Scattered Substances). Thus, while prescriptions have value, they are not perfect. One must carefully select and discard based on sound judgment.

Dong Ji's *Lv She Bei Yao Fang* (Essential Prescriptions for Travelers' Lodges) from the Song Dynasty is noted in the *Siku Quanshu Tiyao* (Synopsis of the Complete Library of Four Treasuries): Dong Ji collected over a hundred effective formulas because he fell ill suddenly while traveling and lacked access to medicine. Formulas for centipede entering the ear and herbal poisoning are particularly urgent and dangerous, yet the remedies are simple. The miscellaneous trauma formulas are rarely seen in ancient books now, appearing unique. These are what ancients called specialized secret formulas, efficacious when used, though their mechanisms might elude even He Huan and Bian Que. I record them for reference.

For centipede entering the ear: Use one spoonful of Chalcanthite powder (Danfan), add a little vinegar, and drip into the ear. The centipede will dissolve into water shortly.
To antidote herbal or insect poison causing suffocation, vomiting blood, and restlessness: Raw Licorice Root (Gancao) 1 liang, raw Alum (Baifan) 5 qian, raw Corydalis Rhizome (Yanhusuo) 1 liang. Grind to fine powder. Take 0.5 qian per dose, decoct in one cup of water until reduced to 0.6 cups, strain, cool, and sip slowly.
For miscellaneous injuries/burns: Immediately moxa the burned area. Endure the intense pain; soon it will cease hurting and not suppurate.
For dog/horse bites, horse bone splinters, or horse blood entering old wounds: Apply hot ash lye to the wound, keeping the container warm. Change the lye frequently to prevent tissue rot. Soak for three to several days. If swelling occurs, heat a stone and apply as a compress twice daily to stop it.
For chronic snakebites or internal venom attack causing pain: Equal parts Realgar (Xionghuang) and Alum (Baifan), ground together. Heat on a knife tip until melted, then apply directly to the bite site for healing.
For preventing snakes from entering body orifices when someone falls drunk or lies on cool ground: Upon seeing a snake, grasp it firmly, cut the tail with a knife, place pepper or spicy substance on the cut, and tie with cotton thread. The snake will exit itself. This snake has a reverse bone; do not pull forcibly. Remember this.
For death by Wall Mirror Snake (Bi Jing) bite: Burn Areca Nut (Binglang) to charcoal. Wash the wound with vinegar first, then apply paste made with vinegar.
Another mild and effective formula: For eye irritation from dust after traveling in wind/rain: Separate the eyelid with fingers and apply saliva to the affected eye.

I occasionally saw excellent marginal comments in Zhang Shucheng's *Yi Xue Liu Yao* (Six Essentials of Medicine) from a friend, though the author is unknown. I excerpt a few items here.
If hundreds of tonics fail, administering one liang of Gun Tan Wan (Rolling Phlegm Pill) cures it.
Ge Kejii's Bu Sui Dan (Marrow Tonifying Pill) uses yellow wax and chicken; these two should not be taken together, as explicitly prohibited in records, so this should be deleted.
A man addicted to alcohol would recover from drunkenness by taking Ge Hua (Flos Desmodii). A doctor said, "This man will not live long; the purgative action is too strong." He indeed died of wind-bi (painful obstruction syndrome).
Acidity regurgitation: Li Dongyuan classified it as cold; Liu Wanhe and Zhu Danxi as heat. People distinguish it by root and branch. We should consider both, but treatments often use Huang Qin and Huang Lian (clearing heat), rarely Ginger and Cinnamon (warming). Can Li Dongyuan's method be discarded? Because common physicians initially use warming dispersants, cold transforms into heat over time, leading to heat-based treatments.
A pregnant woman had frequent, scanty, difficult urination. I cured her by swallowing Liu Wei Wan (Six-Ingredient Pill with Rehmannia) with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), following the method of *Yi Guan*. The next day she refused pills, citing difficulty with Rehmannia, and stopped. Four days later, symptoms recurred. She insisted on a new prescription, so I gave Qing Xin Lian Zi Yin (Clear Heart Lotus Seed Decoction), effective after one dose. Later, checking *Shang Han Zhun Sheng*, I found this was an established ancient method.
Fetal malposition (Zhuan Bao) in pregnancy, caused by the fetus pressing on the bladder, is generally due to deficiency and sinking. Xue's use of Bu Zhong Yi Qi Tang to lift the qi is more stable than Danxi's method of decocting Si Wu, Si Jun, Er Chen and inducing vomiting. Doctor Chen Yuepo from Hangzhou treated the wife of Xie Xuanzi from Yin; one dose restored flow. This is because sinking of clear qi is due to failure of turbid qi to descend. Lifting causes descent; descending causes lifting.
Methods for inducing labor like Zha Mu Yin, Tu Nao Wan, Tong Ming Ru Xiang are insufficient. Only Du Shen Tang (Single Ginseng Decoction) is excellent. My fourth daughter had dystocia for a day and night; after consuming half a jin of Ginseng, she delivered. Gao Gufeng often used Ginseng and [missing herb] 1 liang each, Angelica Sinensis 5 qian, Ligusticum 3 qian, adding Cinnamon Twig in winter to warm.

*Yao Jing* (Medicine Mirror), four volumes, listed in the Medical Category of *Siku Quanshu* as submitted by the Zhejiang Governor. The Synopsis states it was written by Jiang Yi of the Ming Dynasty. Jiang Yi, courtesy name Yi Yong, was from Jiaxing, a Jinshi degree holder in the Zhengde era; his official career is unspecified. The book lacks prefaces or colophons, except for凡例 (General Rules) stating that while *Yi Jing* (Medical Mirror) circulated widely, this new book on drug properties retains the name "Mirror." I obtained a four-volume printed edition from a Wulin bookstore in the seventh year of Xianfeng. It was combined-printed with Wang Yutai's *Yi Jing* (with a preface by Yi Yong dated Xinsi of Chongzhen). It includes a preface by Yi Yong's brother, Yunzhang Yanwen, dated Dinghai of Shunzhi, and Yi Yong's own preface dated Kangxi Year 2. The preface by Yanwen states Yi Yong desired to save the people but failed in officialdom, deciding that medicine was the best way to fulfill his wish without high rank. He studied under Wang Yutai, published *Yi Jing*, and became a guide for students. However, to mirror medicine, one must first mirror drugs. In the year Yihou (Spring/Summer Hongguang Year 1, Autumn/Winter Shunzhi Year 2), amidst war and plague, Yi Yong lived in Beicun, feeling sorrowful. Losing interest in literary exams, he compiled ancient and modern drug properties, edited formulas, and saved poor villagers. He collaborated with Chang Zixin, refined the language, and produced *Yao Jing*. He later retired to farming and selling medicine. The *Synopsis* reflects the submission report. However, *Jiaxing Prefecture Gazetteer* lists only Bu Zuxue's *Yao Jing*, omitting Yi Yong, suggesting an error. I record this for local historians.

Zhang Jieshi criticized *Yi Guan* for using Liu Wei Di Huang Wan for Cold Damage, calling it nonsensical. Ye Tianshi criticized Zhang Jingyue for using Da Wen Zhong Yin for Warm Pathogens, arguing that nourishing yin to induce sweating is treacherous. Zhao Xuecheng favored Liu Wei, while Zhang Jingyue favored Ginseng and Cinnamon. Their biased statements led to harmful trends. Readers must scrutinize their flaws and adopt their strengths.

*Shi Zai Zhi Fang* (Formulas of Shi Zai), two volumes, is the same as Shi Kan's *Zhi Nan Fang* (Guide Formulas) from Shu, mentioned in *Zhi Zhai Shu Lu Ti Jie*. Rare copies exist. I copied it from Luo Jingquan. *Hong Shi Ji Yan Fang* recorded two formulas for female abdominal masses and stabbing pain, along with case records, showing Shi Kan was a capable physician. However, most formulas in his book use Ephedra (Mahuang), Angelica Pubescens (Duhuo), Aconite (Fuzi), and Cassia Bark (Guirui). His Tong Shen San for epidemic toxic dysentery uses Mahuang, Guirui, Gancao, Chuanxiong, Atractylodes (Baizhu), Asarum (Xixin), Duhuo, Platycodon (Jiegeng), Saposhnikovia (Fangfeng), Peony (Shaoyao), Angelica Dahurica (Baizhi), Moutan (Mudanpi), and Morning Glory Seed (Qianniu). The second formula uses Chebula (Hezi), the third uses Sulfur (Liuhuang). Yang Zijian plagiarized these as Wan Quan Huo Ming San. Shi Kan claimed cold pathogen attacking the heart causes water-fire conflict, leading to chills/fever and bloody dysentery due to blood transformation. Kong Yili's *Li Ji Lun* (Dysentery Treatise) severely criticized this as baseless, noting that failing to differentiate constitution and pulse before using harsh herbs like Mahuang, Atractylodes, Cinnamon, Qianniu, Hezi, and Sulfur is murderous. His critique is valid.

Chu Yushi's *Gu Jin Lu Yan Yang Sheng Bi Yong Fang* (Must-Use Formulas for Health Preservation from Ancient and Modern Records) by Lingquan Mountain is rare. In early Xianfeng, Baoshu Tang bookstore in Hangzhou obtained a Song edition from Siming. Ding Baoshu bought it for 6,000 coins. My friend Luo Jingquan, a collector, borrowed a copy for me. *Junzhai Dushu Hou Zhi* says 16 volumes; *Zhi Zhai Shu Lu Ti Jie*, *Song Shi Yi Wen Zhi*, and *Tong Zhi Yi Wen Lue* say 3 volumes, plus *Xu Bi Yong Fang* (1 volume). This copy has upper, middle, lower scrolls. It includes a preface by Imperial Clan member Juanzhi from Shaoping Year 5. It details the origins of many formulas, showing the compiler's care. The scroll opening discusses "Being a Physician": "First assess if a drug is harmful. If harmless, it is beneficial. Once decoctions or pills enter, they cannot be retrieved. Death is irreversible, creating eternal enmity. Benevolent people should heed this." Concise and profound, it serves as a warning for physicians.

Zhang Dairen used only sweating, vomiting, and purging methods. Were there no deficient patients needing tonification then? Even with high skill, this is biased. His cases, likely written by Ma Zhiji et al., often lack pulse descriptions, containing fabrications. Using Zhou Che Wan and Jun Chuan San for severe purging in consumption, deficiency fatigue, and frostbite is questionable. Using Liang Ge San, Si Wu Tang, and Mirabilite for asthma in labor is unsafe. Claiming Mirabilite is safe in months 9-10 of pregnancy is unreliable.

Lei Gong and Bian Que are ancient figures. Qin Yueren of the Warring States admired Bian Que and took the name. Later, Song dynasty *Lei Gong Pao Zhi Lun* referred to Lei Gong. Dou Cai claimed direct transmission, an unprecedented exaggeration.

Yin Fangshu's *Yi Cang Mu Lu* (Catalog of Medical Treasures), one volume, covers medical books from antiquity to recent times, divided into 20 boxes. The first is "Supreme Box," including *Nei Jing*, *Shen Nong Ben Cao Jing*, *Nan Jing*, plus *I Ching*, *Hong Fan*, *Fan Lu*, following Sun Simiao's idea that great doctors must understand Yin-Yang and divination. Chen Yidian's preface praises Fangshu's clinical skill and humble life, compiling unseen books and elucidating ancient wisdom. *Jiaxing Gazetteer* places him in the "Recluses" section, a skilled doctor not seeking fame. He was also a poet (*An Lao Tang Ji*), which I have not seen.

Dong Lian's *Wei Ji Bao Shu* (Precious Book for Protecting Life), obtained by Wu Xiaozheng from Yuan Yongzhi's Song facsimile, has 22 complete chapters, one-third more than the Wen Laotong version. It includes "Additional Formulas" by an anonymous Yuan author.
For venomous snakebite: Tie rope tightly above and below the wound. Apply fragrant Angelica powder (Baizhi) to the wound. Drink half liang mixed with fresh water to eliminate toxin. (Alternative: Hot wine. Most use Ophiopogon water to protect Heart Qi.)
For removing tumors and rat-nipple hemorrhoids: Wash Spurge root (Yuanhua) while wet, avoid iron, grind in stone mortar. Soak a thread in the juice for half a day or overnight. Tie the tumor with the thread. It falls off overnight. Repeat if necessary. Apply Dragon Bone and Chebula powder to the wound. This method works repeatedly. *Su Shen Liang Fang* uses spiders, but it is laborious. Without roots, soaking thread in Spurge flower water works. Zhao used it for a waist tumor; it fell off in half a day without pain.
Er Sheng San for wind-heat sore throat and swelling: Duck-mouth Chalcanthite 2.5 qian, White Silkworm (Jiangcan) 0.5 liang (cleaned). Grind to powder. Blow small amount into throat with bamboo tube for immediate effect.
Lai Su Gao for fright, wind-epilepsy, mental disturbance, phlegm-heat rushing up, tetanus with locked jaw. Use good, worm-free Soap Fruit (Zaojiao), remove skin and seeds, crush. Steep in sour plum water: 5 days (spring/autumn), 2 days (summer), 7 days (winter). Rub, strain, clarify. Boil in porcelain vessel over gentle fire to form a paste. Spread on paper to dry. To use, take palm-sized piece, dissolve in warm sour plum water. Sit patient up, insert bamboo tube into nostrils, blow solution in. Wait for phlegm discharge. This cured countless cases. In Daye Year 6, a 14-year-old official's son suffered from wind-heat phlegm convulsions and locked jaw. Doctors failed. Official Li Souqing used this method, blowing into nostrils. Over a bowl of phlegm was discharged, and he revived instantly.