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Linhai native Hong Yulin stated in his "Nansha Wenshi": My family had a broker who vomited several sheng of blood due to overwork and hardship. A doctor was summoned, who prescribed Chuanlian (Coptidis Rhizoma) and Renshen (Ginseng Radix et Rhizoma), drugs that are excessively cold and tonifying; this accelerated his death. I urgently ordered the cessation of medication, instructed him to consume old rice porridge and rich-tasting foods, and allowed him to rest and eat for several days. Within ten days, he recovered his former strength. This is because people subjected to hard labor rarely enjoy good food; being able to have a few meals at peace is better than fine medicine, so his recovery was inevitable. There was also a sedan-chair porter who was usually healthy but suddenly suffered from lower back pain, abdominal distension, and loss of appetite. The doctor administered strong tonic medicines. That night, his back pain worsened significantly, his abdomen became distended, and he suffered from asthma-like breathing, nearly dying. The next day, the doctor examined him again and said, "This is an affliction by 'Ghost Arrows' (a type of malevolent spirit); medicines cannot work; one must urgently perform exorcism rituals." I sighed, "Why blame ghosts for this!" It was actually Cold Injury with Food Retention. He was given two doses of medicines to dispel cold and transform food retention. By the third day, he could carry passengers as usual. I write this to warn those in the world who mistakenly trust quack doctors. I believe that trusting quacks stems from a lack of familiarity with medical texts, forcing them to seek help from doctors. What is truly hateful is that physicians do not deeply investigate medical principles, yet force themselves to act as experts, causing errors without realizing it.

A physician in Wu Commandery obtained Xu Shuwei's "Shanghan Jiushi Lun" (Ninety Cases of Cold Damage) and treated it as a secret text. Noticing its frequent use of Mahuang Tang (Ephedra Decoction), he treated a woman with febrile disease and no sweating, diagnosing it as a Taiyang Exterior Syndrome of the Foot-Taiyang channel. He administered Mahuang Tang, resulting in unceasing sweating and her death. Generally, true Shanghan (Cold Damage) is rare among southern people. For febrile diseases with no sweating, treating with Zisu (Perillae Folium), Congbai (Allii Fistulosi Bulbus), Douchi (Fermented Soybean), Bohe (Menthae Haplocalycis Herba), etc., is sufficient. How can one rigidly adhere to ancient methods?

Zhu Xi suffered from gout attacks in his later years. Yu Mengda recommended a physician named Zhang Xiuzhi for consultation. Zhang said, "It is necessary to slightly attack and treat the condition to remove stagnation, so that Qi and blood vessels can flow smoothly." Zhu initially hesitated, but Zhang insisted strongly, so Zhu took the medicine. Initially, Huangqi (Astragali Radix) and Husu (Papaveris Pericarpium) were prepared; after taking them, there was slight improvement. Then Baidu (Crotonis Fructus), Sanleng (Sparganii Rhizoma), and Ezhu (Curcumae Rhizoma) were used. He felt his Qi was smooth and steps light, and previous symptoms of food sticking in the esophagus disappeared. However, his large bowels became constipated again. Taking a few pills of Wenbai Wan (Warm White Pill) smoothed the viscera but caused incessant diarrhea. Large doses of Huangya (likely referring to Renshen or similar tonics) and Suidan (a specific pill) were administered, but all were ineffective, leading to his death. Cai Jiufeng's "Mengzang Ji" records this in detail. From this, we know that for elderly patients, one must be extremely cautious about using attacking/draining medicines.

A physician surnamed Hu from Xiangfu County practiced with excellent skill, and officials invited him out of admiration. The daughter of a certain Dudu (Military Governor) had an illicit affair and accidentally contracted a cold illness, summoning Dr. Hu. Dr. Hu deliberately diagnosed her pulse as indicating pregnancy. The Dudu asked, "Is your statement reliable?" Dr. Hu replied, "If I did not recognize it truly, I would not dare to speak rashly." The Dudu then called his daughter forth and cut open her abdomen to verify; it was indeed true. Dr. Hu was terrified and fainted, recovering only after a long time. He fell ill upon returning home and died months later. Dr. Hu's skills were indeed exquisite! Alas, he lacked caution. (My ancestor, Mr. Qiuqi, learned of this while serving as magistrate of Mixian County; my grandmother, Lady Gu, often discussed this matter.)

In recent times, few physicians read the "Neijing" (Inner Canon). Some even arbitrarily quote classics, becoming subjects of ridicule. For example, when treating insomnia, some cite "Banxia Shumi Tang" (Pinellia and Millet Decoction) and "Zusheng Ding" (sores arising from the foot), believing these to be definitive signs. They do not know that "zu" here means "can/able to," not specifically referring to the foot. Others treating Danmalaria (Febrile Malaria) cite "Yinqi xian shang, Yangqi du fa" (Yin qi is injured first, Yang qi acts alone) as a quote from "Yiren Bian," likely having never read the "Neijing" or "Jingui Yaolue," merely seeing this phrase in "Yiren Bian." Such ignorance and crudeness come from those famous for practicing medicine.

Physicians should specialize. Wu Zhanghou, Prefect Duanfu from She County, wrote very earnestly in the "Quan Xingyi Shuo" (Advice on Practicing Medicine) within "Yijian Liangfang." I record it here. In ancient times, physicians each had their own specialty. Recently, I see practitioners who start practicing tomorrow and study today, advertising instruction from both Internal and External masters, even treating Sha, smallpox, and throat diseases. Probing their foundation, they excel in nothing; they merely accumulate many schools to gain wealth. Do they not know that human constitution is limited, how can one excel in everything? Patients do not understand and are often misled. I once saw someone suffering from Fengsha (Wind Rash), whom a doctor mistook for a lacquer allergy and wrongly used clearing/cold medicines. Another patient with Huoyan Ding (Flame Carbuncle) was mistaken by a doctor for a heat sore and wrongly used dispersing medicines, nearly leading to untreatable conditions. All this is due to lack of specialization; how can one not be cautious?

A man surnamed Cao from Suzhou was tall, bearded, and famous for his medical skills, but he held himself in high esteem. Poor families inviting him were often ignored. An old man from a wealthy family had a daughter confined to her boudoir who fell ill and sent a servant to invite Cao. The servant, who hated Cao, lied and said the daughter was already married and pregnant for several months. In Wu customs, women of great families avoided guests; when the doctor arrived, he was to extend his hand through the bed curtains for pulse diagnosis. Cao palpated the daughter's pulse and casually said it indicated pregnancy. The old man was greatly startled. The next day, another doctor was invited, and the old man's son pretended to be the daughter for diagnosis, also saying it was pregnancy. The son lifted the curtain and opened the door, saying, "I am a male, how could I be pregnant? You may slander me, but slandering my sister is unforgivable!" He scolded the servant, beat Cao, forced him to drink feces, and made him kneel and cry for mercy. Only then did they shave his beard, smear chalk powder on his face, and let him go. He returned home, declined visitors, and did not appear for half a year; his reputation plummeted.

Another surgeon, Xie, from the banks of Taihu Lake, had refined skills and good medicines but was greedy and deceitful, often exploiting people's emergencies for profit. When a farmer's mother from a neighboring village sought treatment for a carbuncle, he refused her due to poverty; she died after the carbuncle ulcerated. Someone was furious. Xie was skilled in martial arts, and dozens of men could not approach him. This person hid with a knife in the rice fields, waiting for Xie to emerge, and suddenly stabbed him in the waist. Xie applied his own medicine to heal, but angry at the stabbing, he urgently sued the attacker. Following regulations, the body was inspected. The county official lifted the clothes with excessive force, causing skin rupture; exposure to wind led to re-ulceration and death. The attacker was sentenced according to law but survived after a general amnesty. Both these men had good medical skills; one ruined his name through arrogance, the other harmed his life through greed. Both serve as warnings, so I record them together.

Xu Lingtai stated in "Shenji Chu Yan": In my youth, I saw senior old physicians who carefully assessed the patient's wealth before prescribing. I especially saw those with malicious intentions; at that time, Ginseng prices were high. Physicians claiming fame often liked to use novel/expensive drugs to show off their erudition, disregarding cost. Even worse, some were bribed by pharmacies; whenever diagnosing the rich, they necessarily included expensive ingredients to benefit the pharmacy, which is particularly despicable.

The "Yangzhou Prefecture Gazetteer" notes that Yuan Ti'an's pulse-taking was extremely fast. It states that a physician's pulse diagnosis values prudence as skill, and speed is inferior to such caution. Market physicians act carelessly; Yuan certainly did not do so. Alas! Today's physicians rarely consider speed as skill, and those seeking physicians also value speed. Why not ponder this deeply?

In the south, there is a technique of "cutting mantis eggs," harming children. (Xu Lingtai's "Lantai Guidfan" analyzes this in detail, stating it is the "Jealous Breastfeeding Method," using green coins, 3 qian of Yuanming Powder, 1 qian of Borax, 5 fen of Menthae Haplocalycis Herba, and 1 fen of Borneolum Syntheticum, ground finely and rubbed on the inner cheeks four to five times a day.) In the north, there is a technique of "cutting the navel cord," harming women and children. (Wu Jutong's "Wenbing Tiaobian Zasuo" analyzes this, stating: The character [specific character omitted] does not exist in dictionaries; how can such a disease exist?) These are names fabricated by vulgar people, with techniques secretly passed down by wicked women to deceive the world for profit. Wise people must not be confused by them.

Since we cannot save all people from suffering, we should widely disseminate good prescriptions to fulfill our desire to benefit others. I often see people keeping secret formulas hidden, even using them for profit or extorting heavy fees, which is extremely despicable. Bai Hua of the Tang Dynasty kept a formula for treating back carbuncles secret and subsequently suffered a tiger attack. Jiang Ziyuan of She County kept a formula for antidoting arsenic secret and allegedly received divine punishment. These can serve as warnings.

Niu Gengmei Funong from Wucheng rose from Zhongshu Lang to Langzhong, enjoying great prestige in the capital for over ten years. In March of the 8th year of Xianfeng, he accidentally contracted Wind-Warmth. Chills started from the feet and spread to limbs; body heat, floating pulse, white tongue coating. The doctor diagnosed Wind-Cold and used Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), Fangfeng (Saposhnikoviae Radix), Cang'erzi (Xanthii Fructus), etc., leading to coma, agitation, and cold extremities. The coating turned yellow, bowels became constipated. A changing doctor used Shigao (Gypsum Fibrosum) and Dahuang (Rhei Radix et Rhizoma), making the condition critical. Another doctor used Liyin Jian (Replenish Yin Decoction) and Fumai Tang (Restore Pulse Decoction), but ultimately failed to save him. He died at age 56. Gengmei was my uncle-in-law, husband of Mr. Zhou Yutang's daughter. He was studious, virtuous, and dignified; everyone thought he would live a long life and achieve high rank, yet he was killed by quack doctors. It is regrettable! I observe that in Wind-Warmth and Damp-Warmth syndromes, if wind-dispersing ascending drugs are used, latent heat sinks into the Pericardium, inevitably leading to coma and cold extremities leading to death. At this point, using Qingying Tang (Clear Nutrient Decoction), Zhibao Dan (Treasure of Wisdom Pill), or Zixue Dan (Purple Snow Pill) to cleanse the Middle Jiao might still salvage the situation. If misdiagnosed as Yangming Channel/Fu syndrome and errors repeat, the path to life is cut off.

Work should be done calmly and cautiously; medicine requires even more caution. Not only must the disease be accurately diagnosed, but prescriptions must not be rushed to avoid error. A Hangzhou physician treating febrile disease prescribed 7 fen of Xijiao (Rhinocerotis Cornu), but mistakenly wrote 7 qian. After ingestion, chest pain and shortness of breath led to death. The patient's family threatened legal action, resolved only by heavy bribery. Another physician treating Summerheat used Liuyi San (Six-to-One Powder) plus Huashi (Talcum), which was ineffective and heavily criticized by the patient's family. All these faults stem from negligence.

The method for treating carbuncles and ulcers should not lightly use knives. For puncturing abscesses, one must precisely study acupoints; otherwise, inadvertence will harm the patient. Past events serve as warnings. In Hangzhou, a benevolent person set up a bureau to invite doctors to save the poor. Surgeon Li was among them. A farmer had a carbuncle on his foot; Li's incision severed a major tendon, rendering him disabled. The farmer's family beat Li nearly to death. In our village, a wandering practitioner treated asthma by piercing the chest with a needle, injuring the heart; the patient died instantly, and the doctor fled that day.

Zhou Minfan Xueyuan Xueyuan from Wucheng was talented and elegant. In the 9th year of Xianfeng, he ranked second in the First Class of the Grand Examination, promoted from Compiler to Assistant Scholar of the Hanlin Academy. Soon after, he suffered mourning for his father, returned home for eleven years, and hid from turmoil in southern Tiao. He had had a tumor on his buttock for years. Due to inconvenience in sitting and lying, he sought treatment from Surgeon Fei of Linghu. Fei said it could be removed with medicine, administering "Sanpin Yitiaoqiang" (Three-Piece Single-Barrel Gun, a toxic herb preparation). After severe pain for several days, the lesion ulcerated and everted. Then "Wuhu San" (Five-Tiger Powder) containing Wugong (Scolopendra), Qianglang (Staphylinidae), and Quanxie (Scorpio) was administered. After ingestion, he became physically exhausted and mentally confused, dying suddenly at age forty. In past years, when I taught in Huzhou and resided in Beijing, I often discussed arts and current affairs with Minfan, forgetting fatigue morning and night. Hearing of his death, I deeply hate the toxicity of quack doctors, comparing them to bandits. I write this to express grief. (That year, while hiding in Liusi, a neighbor girl Chen Guijie had a carbuncle on her hand. She was also operated on by Fei, who severed tendons, causing severe pain and inability to heal. She came to me for treatment and recovered. Generally, modern surgeons follow the methods of "Waike Zhengzong" (Orthodox Manual of External Medicine), using only harsh/potent drugs, harming many. Students should take this as a warning.)