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Medical principles are extremely profound; how can they be easily explained? Moreover, since the times of Xuanyuan Huangdi (Yellow Emperor) and Qibo, there have been no lack of experts in each generation, and their discussions have already been detailed and exhaustive. Why should I add my words? Furthermore, as a young man with shallow learning and limited insight, I merely wish to express my own thoughts. Is it necessary for me to speak? Therefore, amidst my extensive reading, I casually record and narrate, just to amuse myself. The content is shallow and the language trivial, perhaps what is meant by "speech lacking literary grace." If speech lacks literary grace, it is acceptable; but if speech contradicts medical principles, it will only invite blame. Thus, I dare not hide these thoughts, but seek correction from the gentlemen of the present age.

In the twelfth month of the eighth year of Xianfeng, Lu Yitian wrote this at Lenglu (Cold Cottage) in the Hangzhou official residence.

Xu's *Yitong* states: In ancient times, medicine was divided into fourteen departments, one of which was the Department of Spleen and Stomach, which has now disappeared. There are many such references in the *Daozang Jing* (Daoist Canon). During the Song and Yuan dynasties, the sequence included the Departments of Throat, Mouth, and Teeth; Chuangyang (Surgery); Zhenggu (Orthopedics); Jinzu (Arrow wounds); Yangsheng (Health preservation, i.e., Daoist exercises like Daoyin, massage, and breathing techniques); and Zhuyou (Spiritual healing, i.e., talismans and prayers used in Taoism). The scripture says: "Those who can shift spirit and change qi can be treated by Zhuyou alone." Our dynasty (Qing) retained only thirteen departments, and the Department of Spleen and Stomach was never resumed. *Leijing* states that medical arts consist of thirteen departments: Dafangmai (Internal Medicine), Furen (Gynecology), Shanghan (Cold Damage), Chuangyang (Surgery), Zhenjiu (Acupuncture and Moxibustion), Yan (Ophthalmology), Kouchi (Mouth and Teeth), Houyan (Throat), Jiegu (Bone Setting), Jinzu (Arrow Wounds), Anmo (Massage), and Zhuyou. Currently, Massage and Zhuyou have been lost. These two accounts differ slightly. However, the thirteen departments established by the Imperial Medical Bureau were consistent with the account in *Leijing*, as detailed in the *History of Ming*. I observe that recently there have been specialists in otology (ear diseases), which falls outside these traditional departments.

Jin Runhuan Ke, a famous physician from Qiantang, treated extremely difficult and critical cases with composure. He often said: Famous physicians in ancient times were called "He" and "Huan"; why act in haste? This statement serves as a critique of vulgar doctors.

Physicians practicing across five generations include Xu Zhicai of Northern Qi, Wei Yilin of the Yuan Dynasty, and Chen Zhi of our dynasty (from Huating). Physicians practicing across three generations include Zhang Gao, Chen Ziming, Ni Weide, and Lu Shilong of the Song Dynasty, who were the most renowned. In modern times, many families have continued the profession; He Ziyuan from Beishan, Qingpu, has practiced for twenty-four generations.

Zhang Hezi said: In ancient times, physicians were regarded as teachers, so the Way of Medicine flourished. Now, physicians are treated like slaves, so the Way of Medicine declines. Ambitious scholars feel ashamed to learn it, and patients do not distinguish between skilled and unskilled practitioners, treating them all alike. It is common to see imperial physicians greeting officials and calling out before their horses, which is truly shameful. Consequently, those who are well-versed in past and present are few, and teacher-student lineages are severed. Alas! Are imperial physicians calling out before horses really considered shameful? Today, officials flattering their superiors commit acts far more shameful than this, let alone physicians. Chen Zai'an from Shanyin cured his county magistrate and was recommended to higher authorities to serve as an imperial physician in the prefecture, but he firmly declined. When offered a place in the merit registry to abandon medicine for officialdom, he again declined. This shows he far surpassed ordinary people.

Physicians often enjoy long life. Roughly counting them: Hua Tuo of Wei lived over a hundred years; Wu Pu lived over ninety; Ge Hong of Jin lived to eighty-one; Xu Zhicai of Northern Qi lived to eighty; Yao Sengyuan of Northern Zhou lived to eighty-five; Xu Zhizhuang lived to eighty; Sun Simiao of Tang lived over a hundred; Zhen Quan lived to one hundred and three; Meng Shen lived to ninety-three; Qian Yi of Song lived to eighty-two; Li Qingsi of Jin lived over eighty; Cheng Wuji lived over ninety; Zhu Zhenheng of Yuan lived to seventy-eight; Dai Yuanli of Ming lived to eighty-two; Wang Ji lived to seventy-seven; Zhang Jianbin lived to seventy-eight; Xu Lingtai (Da Chun) of modern times lived to seventy-nine; Ye Tianshi (Gui) lived to eighty. Presumably, because they mastered medicine, they could explore the essence of life and understand proper nourishment, thereby preserving their natural lifespan.

Ye Tianshi treated a patient named Jin suffering from vomiting for several years. After using herbs to drain the Liver and calm the Stomach for over a year, the patient nearly died. Xu Lingtai diagnosed it as accumulation of fluid retention (Shuiyin) and prescribed a formula, after which the illness immediately resolved (see *Xu Pi Linzheng Zhinan*). Xue Shengbai treated Cai Fuyi, who collapsed upon returning home on a summer day, with faint breath, closed eyes and mouth, and deep, hidden pulses. His wife's brother wept nearby, and relatives discussed funeral arrangements, diagnosing it as Phlegm Syncope (Tan Jue) and suggesting no prescription was needed, only administering Du Shen Tang (Single Ginseng Decoction). Everyone hesitated. A Mr. Fu from Changshu, who ran a clinic in Fengqiao, was invited. Mr. Fu said: This is heatstroke; Ginseng is contraindicated. One should take a formula to clear and disperse heat. As the theories conflicted, everyone remained hesitant. His tutor, Feng Zaitian, said: I hear Liu Yi San (Six-One Powder) can dispel pathogenic heat. Why not try it first? Everyone agreed. It was administered via a reed tube, and the patient gradually revived. Mr. Fu then administered heat-resolving agents, and the patient recovered completely (see Xu Huitang's *Tingyu Xuan Zajiji*). Even great physicians like Ye and Xue are not immune to error; thus, medicine is difficult. Yet, someone like Mr. Fu, unknown beforehand, cured a case mismanaged by great physicians, proving that while medicine is hard, it is possible.

Wu Xiaozheng Maocai (Jiansen) from Zhenze recounted that during the Qianlong era, a major epidemic struck Suzhou. The prefecture set up medical bureaus to help the poor, and famous physicians visited daily. A night watchman came with severe edema, his body and face swollen and yellowish-white. Xue Shengbai examined him first, waved him away, saying: Severe edema is incurable. After the patient left, Ye Tianshi arrived, looked at him from his sedan chair, and asked: Are you not the night watchman? This is caused by toxicity from mosquito repellent belts. Two doses will cure it. He prescribed medicine. Xue Shengbai turned pale, leading to the rivalry between their schools (Saoye Zhuang and Taxue Zhai). This account comes from a Suzhou physician Gu, who learned it from his master, who witnessed it. Xu Lingtai's *On the Difficulty of Being a Famous Physician* states that famous physicians command high prices. Patients delay seeking treatment until conditions are critical, when other doctors give up. Then they turn to the famous doctor with high expectations and heavy demands, as if holding power over life and death. If the patient dies, the doctor can leave citing the inevitable outcome. If there is a sliver of hope, using mild remedies to shirk responsibility may lead to death, causing guilt; using strong remedies is risky and invites criticism if things go wrong, bearing all blame for previous errors. Thus, treating patients is harder for famous physicians. This applies to true masters. But for fashionable physicians seeking false fame, lacking real skill and driven by greed, who treat everyone indiscriminately: those hired with heavy fees might be careful, but casual consultations are rushed and careless. My younger brother and son both died due to misprescriptions by famous physicians. (My brother, having stayed up late moon-viewing on Mid-Autumn Festival, developed chills and fever the next day. Misdiagnosed as cold exposure, he was given Guizhi Tang variants, causing pathogenic factors to sink inward and cloud the mind, missing the latent Summerheat syndrome. My son Baozhang had internal wind syndrome, misdiagnosed as external wind, and was given Quanzhe and Niuhuang, leading to complications.) Due to rushed examinations without thorough assessment, famous physicians must limit their daily caseload. If exceeded, refer patients elsewhere. This allows for calm diagnosis and careful prescribing, avoiding fatal errors.

The *Yangzhou Prefecture Gazetteer* states that Zheng Zhongguang's pulse diagnosis inherited the methods of Wu Pu and Xu Shumi, ranking above Hua Shou. The *Jiangdu County Gazetteer* placed him in the "Biography of Earnest Conduct," while the *Yizheng Continuation Gazetteer* placed him in "Technicians" but praised him only vaguely. Sima Qian detailed the skills of Bian Que and Sima Jizhu in their biographies because people are remembered for their skills; without detailing skills, recording the person is insufficient. This view aligns best with historiographical principles. Modern writers biographizing physicians often use empty praise, failing to list successful treatments or detailed prescriptions, showing ignorance of biographical standards.

Mr. Wang Fengting Youliang, in his brief biography of Ye Tianshi, stated that from age twelve to eighteen, Ye studied under seventeen different masters. Hearing of someone skilled in a specific condition, he would respectfully study under them, learn the technique, and then move on, thus accumulating excellence to achieve fame. Well said! Learning from multiple teachers is the way to refine one's art.

The *Shaoxing Prefecture Gazetteer* records Jin Lu, grandfather of Jin Taichang Lan from Shanyin, who specialized in infant care, disregarding profit, enduring cold and heat, and helping the poor before the rich. While local doctors rode in sedans, Jin walked even in his eighties, saying: I want poor children to receive some benefit. Another Shanyin resident, Sun Xiehe, dedicated himself to saving lives, specializing in Traditional Chinese Medicine. He treated patients regardless of wealth, examining carefully and consulting texts, neglecting food and sleep. These serve as models.

Without broad knowledge, a physician cannot treat complex cases. I cite two examples. In Guangdong, a daughter of the Lv family was persecuted by her stepmother Yin, who pretended to love her but poisoned her clothes with camphor powder mixed in rice paste. The girl suffered incessant itching and swelling, resembling Leprosy. Treatment failed for a year. No doctor dared visit, and she was to be sent to a leper colony. Unwilling, Lv sought Dr. Cheng. Cheng observed her pulse and complexion, noting no turbid marks on the face and constant scratching. He concluded: This is caused by toxic clothing. Wash the clothes. The rinse water was yellow-black and pungent. Cheng said: Camphor powder damages flesh. This is poisoning by the washerwoman, not leprosy. Discard the clothes, and the disease will heal. It worked. Lv discovered the truth and divorced Yin (see *Dongguan Ousu Tailou Shenglan*). My relative Ms. Wang suffered from widespread red nodules, pain, and itching, reducing her appetite. Doctors treated it as sores for weeks without success. Famous physician Zhang Menglu examined her closely and said: This is caused by bedbug bites. No treatment needed. Returning home, she found countless bedbugs in her bedding, and she recovered.