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(There are fifty-one questions and answers in total.)

A person asked: Regarding the origins of medicine, since the time of Xuanyuan (Yellow Emperor) and Qibo, how many people have become famous for their medical skills, or written books to establish doctrines, so that future generations could take them as models? Please tell me clearly. I replied: I once read the writings of the late Academician Song Jinglian (Song Lian) and obtained the explanation within; please allow me to state it as follows: The *Huangdi Neijing* (Yellow Emperor's Inner Canon), although suspected to be fabricated by scholars of the Pre-Qin period based on imitation, has words that are profound and essential, and its purport is deep and grand. Its examinations and distinctions are credible and well-attested; thus, it should be regarded as the ancestor of all medical schools. Below this level are Qin Yueren (Bian Que), He, and Huan. He and Huan left no transmitted works; Yueren's *Nanjing* (Classic of Difficult Issues), consisting of eighty-one difficult issues, enumerates the essentials of the *Neijing* and elaborates upon them. Below these are Chunyu Yi and Hua Tuo. Hua Tuo's "bear hanging and owl looking" (Xiongjing Chigu, a form of Daoyin/qigong exercise) was indeed one technique among Daoyin practitioners. However, his practices of disemboweling bellies and backs, and washing intestines and stomachs to remove diseases, verge on the miraculous and strange. Sima Qian recorded in detail the medical cases of Chunyu Yi. What he called "Jiongfeng" and "Dafeng," modern people do not know at all what diseases they refer to, let alone seek their profound principles of treatment. Below these are Zhang Ji's (*Zhang Zhongjing*) *Jingui Yuhan Jing* (Golden Casket Jade Box Classic) and various treatises on *Shanghan* (Cold Damage). These are truly immortal classics unchangeable for millennia. Yet, they detail injuries caused by the six qi (wind, cold, summer heat, dampness, dryness, fire) but briefly discuss those caused by desires, diet, and fatigue. Moreover, the text suffers from disordered bamboo slips, making it difficult to arrange in order. Below these is Wang Shuhe. Shuhe compiled the books of Qibo, Hua Tuo, etc., into the *Maijing* (Pulse Classic). He narrated yin and yang, interior and exterior; distinguished the three positions and nine inspections; separated the Renying and Qikou pulses; and systematically described the twelve meridians, as well as diseases of the Sanjiao (Triple Burner), five zang organs, and six fu organs. This was most clear and distinct. Unfortunately, Gao Yangsheng abridged it into superficial pulse songs, causing his original book to fail to circulate widely in the world. Below him was Chao Yuanfang. His compilation of the *Bingyuan Hou* (Source and Manifestations of Diseases) seemed not without insight, but his failure to include texts on damp-heat while only discussing wind-cold was his deficiency. Below him was Wang Bing. Bing deduced the changes of the Five Movements and Six Qi, writing the *Tianyuan Yuce* (Jade Register of the Heavenly Origin). It was comprehensive, detailed, and precise, which was difficult for others to achieve. However, if one adheres rigidly to it, one becomes limited and inflexible. Below him were Wang Tao and Sun Simiao. Simiao possessed extraordinary knowledge and held a heart of compassion and pity. In narrating the *Qianjin Fang* (Prescriptions Worth a Thousand Gold) and *Qianjin Yifang* (Supplement to Prescriptions Worth a Thousand Gold), and denouncing the disasters caused by incompetent physicians, he was extremely indignant and urgent. Those who later slightly penetrated his walls could also become famous for their skills, though the lack of a specific book on Cold Damage might be a regret. Tao, although elucidating the *Waitai Miyao* (Secret Essentials of the External Cabinet), detailing prescriptions, indications, talismans, moxibustion, and acupuncture, followed ancestral traditions. However, his view that acupuncture can kill living people but cannot revive the dead was a one-sided opinion. Below them were Qian Yi, Pang Anchang, and Xu Shuwei. Shuwei operated within standard measurements without significant innovation. Anchang could produce unexpected responses but ultimately did not depart from established norms. Both merely grasped the superficial aspects of Zhang Ji. Only Qian Yi deeply explored the mysteries of Zhang Ji and extracted his essence. He established formulas for the five zang organs according to their suitability, stating that the Liver possesses Ministerial Fire, thus requiring draining rather than tonifying; the Kidney is True Water, thus requiring tonifying rather than draining. These insights unlocked the secrets of the *Neijing* and became models for knowledgeable practitioners. The world regards him merely as a pediatrician, showing how shallow their understanding of Yi is. His surviving works were collected by Yan Xiaozhong, reflecting much of Yan's own ideas rather than Yi's true originality. Below them were Zhang Yuansu of Shanggu, Liu Wansu of Hejian, and Zhang Congzheng of Suiwater. Although Yuansu and Wansu used dreams and strange figures to mystify their transmission, they were actually inspired by the reputation of Qian Yi. As for Congzheng, he followed Wansu. Yuansu believed ancient formulas could never fit modern diseases, treating patients without relying on fixed formulas; thus, his books did not survive. What exists today are later interpolations. His learning was deeply inherited by Li Gao of Dongyuan. Li Gao elucidated internal and external injuries, focusing heavily on tonifying Spleen Earth. Since Earth is the master of the body, when Earth is balanced, all organs are balanced. Congzheng considered the three methods of vomiting, sweating, and purging, and the six categories of wind, cold, summer heat, dampness, dryness, and fire, as the keys to medicine. His treatments often involved aggressive draining; those who learned poorly from him would kill people. Wansu discussed wind-fire diseases, basing his *Yuanbingshi* (Original Formulas for Disease Causes) on the nineteen pathogenic mechanisms of qi and suitability in the *Neijing*. His work was profound and subtle, beyond the reach of officials' bureau physicians. His methods, however, remained within the realm of draining and tonifying. Famous modern physicians include Luo Yi of Wuzhong and Lu Fu of Cangzhou, who inherited Li Gao's legacy; Luo Zhiti of Wulin and Zhu Danxi (Zhu Zhenheng) of Danxi, who drew from Wansu's influence. Others like Zhu Zuo of Taizhou and Hua Shou of Yuezhou also had publications, too numerous to list. Alas! Since the *Neijing*, there have been 179 families, 209 volumes, and 1,259 scrolls of medical books stored in government offices—a considerable amount. As for famous physicians of past dynasties, I mention only the best here; how could I list them all?

Someone asked: Having heard the origins of medical transmission, I wonder, Master, from whom does your learning derive? The tradition says: "If a physician is not from three generations, do not take his medicine." Some say this means hereditary succession from grandfather to grandson. Others say it means being skilled in reading the books of the Three Dynasties makes one a physician of three generations. Do you read the books of the Three Dynasties? Or do you follow a hereditary family tradition? Please explain clearly. I replied: Can my rustic learning be spoken of? However, medicine is not limited to three generations, nor are books limited to the Three Dynasties. One should select what is worthy of emulation. My fellow townsman, Mr. Zhu Zhenheng (Danxi), inherited the learning of Liu, Zhang, and Li, and found his foundation in Luo Taiwu. He became renowned for his medical arts in his time, and people near and far took him as a model. My late great-uncle, Lord Chengzhai, happened to live in the same era and village as Danxi, thereby benefiting from his direct instruction. He also became famous for his skills. Thus, my hereditary family transmission has its origins. I only regret my dull talent and inability to carry forward our ancestral achievements. What is there to boast about?

Someone asked: What is the meaning of "Excess causes harm, and succession brings restraint"? I replied: Wang Andao discussed this in detail, but some points remain unclear. Please allow me to state the outline: The Yellow Emperor said: "I wish to hear how geography corresponds to the six qi and seasonal positions." Qibo said: "To the right of Xianming is the position of Sovereign Fire. To the right of Sovereign Fire, moving backward one step, Ministerial Fire governs; moving back another step, Earth Qi governs; moving back another step, Metal Qi governs; moving back another step, Water Qi governs; moving back another step, Wood Qi governs; moving back another step, Sovereign Fire governs. Below Ministerial Fire, Water Qi succeeds it; below the Water position, Earth Qi succeeds it; below the Earth position, Wind Qi succeeds it; below the Wind position, Metal Qi succeeds it; below the Metal position, Fire Qi succeeds it; below Sovereign Fire, Yin Essence succeeds it. Excess causes harm; succession brings restraint. Restraint allows for transformation and generation; externally, prosperity and decline are displayed. Harm leads to chaos and disorder; transformation and generation lead to major disease. Among the Five Elements, Wood, Earth, Metal, and Water each have one, but Fire has two: Sovereign Fire and Ministerial Fire. In geographical distribution, they occupy six directions; in seasons, they divide into six qi. The first qi, from Chou to Mao, begins at Great Cold and ends at Spring Equinox, governed by Jueyin Wind-Wood. The second qi, from Mao to Si, begins at Spring Equinox and ends at Grain Full, governed by Shaoyin Sovereign Fire. The third qi, from Si to Wei, begins at Grain Full and ends at Great Heat, governed by Shaoyang Ministerial Fire. The fourth qi, from Wei to You, begins at Great Heat and ends at Autumn Equinox, governed by Taiyin Damp-Earth. The fifth qi, from You to Hai, begins at Autumn Equinox and ends at Light Snow, governed by Yangming Dry-Metal. The final qi, from Hai to Chou, begins at Light Snow and ends at Great Cold, governed by Taiyang Cold-Water. 'Xianming' refers to direction, where the sun rises at Mao. Shaoyang Sovereign Fire starts here and moves right, hence 'right of Xianming.' Heaven and Earth rotate left, while the six qi rotate right, hence 'moving backward.' Below each of the six positions lies the element that overcomes it, succeeding it. Wang said 'succession' implies following, but also hindering. Because the lower serves the upper, it is called succession. The way of the Five Elements is: if not excessive, it simply follows; once excessive, it arises to overcome and defeat. Someone asked: Restraint, what does it restrain? Harm, what does it harm? Restraint restrains the excess of qi; harm harms the primordial qi of the successor. Primordial qi, generally speaking, is called One Yuan; specifically, it is called Six Yuan. One Yuan: Heaven generates Water, Water generates Wood, Wood generates Fire, Fire generates Earth, Earth generates Metal, Metal returns to generate Water, cycling endlessly, generating life without cease. Six Yuan: Water is the transforming source of Wood, Wood of Fire, Fire of Earth, Earth of Metal, Metal of Water. They transform and operate infinitely. If Fire is not excessive, the succeeding Water simply follows; if excessively excessive, Water arises to calm it, fearing harm to our Metal-Yuan qi—this is the son saving the mother. The same applies to the six qi. This is the principle of Five Element victory and revenge, happening spontaneously. 'Restraint allows transformation and generation' means there is a constant of restraint; if excessive, it is restrained, and transformation continues without cease, so what harm is there? 'Externally, prosperity and decline are displayed' means the succeeding force is weak, while the excessive force is extremely strong, and restraint is incomplete. In heaven and earth, this is the six excesses (pathogens); in the human body, it is the six diseases. 'Harm leads to chaos and disorder' means the variation of no restraint. The successor is severely depleted and lacks qi, so the excessive force runs rampant and unstoppable. In heaven and earth, the great earth perishes; in the human body, the true qi dies. This is the general idea, not fully detailed. Students should refer to Andao's discussion for completeness.

Someone asked: In Mr. Danxi's *Gezhi Yulun*, he states: "Yang is often in excess, Yin is often deficient. Qi is often in excess, Blood is often deficient." However, in his various prescriptions, he frequently mentions Qi deficiency, Blood deficiency, Yang deficiency, and Yin deficiency. Why is there such self-contradiction? What is the meaning? I replied: His discussion of the deficiency and excess of yin, yang, qi, and blood, compared with the superiority and inferiority of heaven and earth, sun and moon, contains profound and obscure principles that only the wise can understand. Please allow me to state the outline: When he says "Yang is often in excess, Yin is often deficient," regarding heaven and earth, it applies to all things; regarding the human body, it applies to the whole body. It does not directly point to Qi as Yang and Blood as Yin. The Classics say: "Within Yang there is Yin, and within Yin there is Yang." This is exactly what is meant by "Solitary Yang does not generate, solitary Yin does not grow." Let us discuss treatment methods and symptoms. Saying "Qi deficiency" refers to Yin deficiency within Qi; the treatment method uses Sizijunzi Tang (Four Gentlemen Decoction) to tonify the Yin within Qi. Saying "Blood deficiency" refers to Yin deficiency within Blood; the treatment method uses Siwu Tang (Four Substance Decoction) to tonify the Yin within Blood. Saying "Yang deficiency" refers to deficiency of Prime Yang in the Heart Meridian; symptoms often include aversion to cold, attributed to lack of Fire. The treatment method adds Aconite (Wutou) and Prepared Rehmannia Root (Fuzi) to Qi-tonifying herbs; severe cases use Sanjian Tang or Zhengyang San. Saying "Yin deficiency" refers to deficiency of True Yin in the Kidney Meridian; symptoms often include high fever, attributed to lack of Water. The treatment method adds Anemarrhena Rhizome (Zhimu) and Phellodendron Bark (Huangbai) to Blood-tonifying herbs, or uses Dabuyin Wan (Great Tonifying Yin Pill) or Ziyin Dabu Wan. The Classics say: "For those whose heat persists despite cooling measures, seek the Yin; for those whose cold persists despite warming measures, seek the Yang. This is called seeking their affiliation." Wang's commentary says: "This means tonifying the source of Fire to eliminate Yin shadows, and strengthening the master of Water to control Solar brilliance." When True Water is extremely depleted, one must absolutely not administer warming Yang herbs like Aconite, lest they assist Fire evil and scorch True Yin. When Prime Yang is extremely deficient, one must not administer acrid, dispersing, and bland-draining agents like Ligusticum Wallichii (Chuanxiong) and Poria (Fuling), lest they open the pores and leak True Qi. Ignorant people believe Qi deficiency is Yang deficiency, usable only with Sizijunzi Tang, never with Chuanxiong-type herbs; Blood deficiency is Yin deficiency, usable only with Siwu Tang, never with Ginseng-type herbs. They do not realize that Li Gao said: "When Yang is vigorous, it can generate Yin Blood" (here, Yin and Yang directly refer to Qi and Blood). He also said: "Replenishing Qi in cases of Blood loss is the method of the ancient sages." For Blood deficiency, one must use Ginseng to tonify, following the principle that Yang generation leads to Yin growth. Only in cases of True Yin deficiency approaching exhaustion should Ginseng be avoided, as it may not withstand the condition and反而 worsen it; this is not a contraindication for simple Blood deficiency. Wang Ruyan, though insightful, failed to grasp this principle. In his *Mingyi Zazhuo*, he stated: "In recent times, treating diseases, whenever a deficiency syndrome is seen, Ginseng and Astragalus are used. This is suitable for Qi deficiency, but for Blood deficiency, does it not assist Qi and consume Yin Blood?" He claimed that treating Blood disease by regulating Qi makes Blood more deficient. He further said: "If Blood deficiency patients mistakenly take sweet-warm herbs like Ginseng, the illness increases daily; taking too much leads to untreatable death." Sweet-warm herbs assist Qi, belonging to Yang; when Yang is vigorous, Yin diminishes further. He also said: "After childbirth, women suffer Yin Blood deficiency, leaving Yang without support, floating and scattering outward, causing frequent fever. Only Siwu Tang should be used to tonify Yin Blood, combined with roasted Dried Ginger for its bitter-warm counter-treatment to gather the floating Qi and return it to Yin support. Ginseng should be avoided." Danxi said: "Postpartum conditions should primarily be treated with great tonification of Qi and Blood." If Yang floats outward due to lack of support, how else can Ginseng-type herbs rescue scattered Qi? Alas! How does Ruyan's argument contradict both Li Gao and Danxi? Dogmatic individuals are everywhere; I cannot refrain from refuting this.

Someone asked: Ancient medicine employed four diagnostic methods. What are they? I replied: They are Form, Sound, Color, and Pulse. Modern people only emulate pulse diagnosis, knowing one part while neglecting the other three. Please allow me to explain the rationale: Form diagnosis involves observing the physical form to know the disease. The Classics say: "If Form and Qi are deficient, but Pathogenic Qi is abundant, this is Evil triumphance; one should drain, not tonify. If Form and Qi are abundant, but Pathogenic Qi is deficient, one should tonify, not drain. If both Form/Qi and Pathogenic Qi are deficient, this is deficiency of both Yin and Yang; one must urgently tonify. Acupuncture is contraindicated; needling causes double deficiency. Double deficiency leads to exhaustion of Yin and Yang, depletion of Blood and Qi, emptiness of the five zang organs, withered sinews and bones, death for the elderly, and irrecoverability for the strong." If Form and Qi are abundant, and Pathogenic Qi is abundant, this is excess of both Yin and Yang; one must urgently drain the Evil and regulate deficiency and excess. Hence, "Drain the excess, tonify the deficiency." This is what is meant. It is also said: "If flesh and form are wasted, even if the nine pulses are regular, death ensues." It is said: "The head is the mansion of clarity and spirit; if the head droops and eyes are sunken, the spirit is being seized." The back is the mansion of the chest; if the back is curved and shoulders hang, the fu organs will deteriorate. The waist is the mansion of the Kidneys; if turning and shaking are impossible, the Kidneys are failing. Bones are the mansion of Marrow; if one cannot stand long and trembles when walking, the bones are failing. All such cases constitute Form diagnosis. Sound diagnosis involves listening to sounds to verify disease. The Classics say: "A voice sounding as if coming from a room indicates Dampness in Middle Qi. Speech that is faint, repeating only after a whole day, indicates Qi depletion. Disheveled clothing, inappropriate speech regardless of intimacy, indicates confusion of Spirit." He Shuhe said: "In chronic illness, hoarseness indicates death. In children's illness, sudden crow-like sounds indicate death." Li Gao said: "Speech starting light and becoming heavy, loud and powerful, indicates excess of external contraction; speech starting heavy and becoming light, deep and weak, indicates deficiency of internal injury." All such cases constitute Sound diagnosis. Color diagnosis involves observing the five colors of the face to detect disease. The Classics say: "Red should resemble silk wrapping cinnabar, not hematite. White should resemble goose feathers, not salt. Green should resemble the luster of dark jade, not indigo. Yellow should resemble silk wrapping realgar, not yellow earth. Black should resemble lacquered wood, not dark soil." It is also said: "Green like withered grass indicates death; yellow like immature orange indicates death; black like [missing character] indicates death; red like [missing character] blood indicates death; white like dry bones indicates death. These are the five colors indicating death. Green like kingfisher feathers indicates life; yellow like crab belly indicates life; red like chicken comb indicates life; white like pig fat indicates life; black like crow feathers indicates life. These are the five colors indicating life. Life in the Heart resembles silk wrapping cinnabar. Life in the Lung resembles silk wrapping red. Life in the Liver resembles silk wrapping bluish-purple. Life in the Spleen resembles silk wrapping trichosanthes fruit. Life in the Kidney resembles silk wrapping purple. These are the external manifestations of the five zang organs. To observe the five evils of the zang organs, one must distinguish the seasonal command colors. The Classics say: "Coming from the preceding organ is Excess Evil (Son makes Mother excess). Coming from the following organ is Deficiency Evil (Mother makes Son deficient). Coming from the conquered organ is Minor Evil (Wife usurps Husband's position). Coming from the conquering organ is Robber Evil (Ghost thief causes harm). Self-disease is Correct Evil (Self-injury of the primary meridian)." For example, in Spring when Wood is vigorous, if the patient's color is green with a tinge of red, it is Excess Evil. Though sick, it is easy to treat; the method is "Drain the Son of the Excess." If the color is green with a tinge of black, it is Deficiency Evil. The illness is also easy to treat; the method is "Tonify the Mother of the Deficiency." If the color is green with a tinge of yellow, it is Minor Evil, especially easy to treat; the method is "Counteract the Minor," known as Direct Treatment. If the color is green with a tinge of white, it is Robber Evil, difficult to treat and often fatal; the method is "Follow the Severe," known as Counter-intuitive Treatment. If the color is merely green like the luster of dark jade, it is Correct Evil, self-disease of the primary meridian, healing without medication. The four seasons follow this deduction. Furthermore, red and yellow tones in any season are auspicious; green and black are inauspicious. Such cases are the key secrets of Color diagnosis; can students ignore them?

Someone asked: The pathogen of Cold Damage enters the body without fixed form. Yet, the hands and feet each have six meridians. Why does it only transmit through the foot six meridians and not the hand six meridians? Liu Caochuang said: "The foot six meridians belong to Water, Earth, and Wood. Water freezes in cold, Earth cracks in cold, Wood loses leaves and withers in cold. The hand six meridians belong only to Metal and Fire. Fire overcomes Water and resists cold; Metal becomes harder in cold." The logic seems clear. How do you comment on this? I replied: The statement seems reasonable but is actually incorrect. Please allow me to state a personal insight: Humans have bodies, reaching heaven and treading earth. The upper half is governed by Heaven Qi; the lower half is governed by Earth Qi. Thus, the upper body is mostly affected by Wind-Heat, and the lower body by Cold-Dampness. Regarding the six seasonal qi: the first three correspond to Spring and Summer, where qi ascends and floats, promoting growth; thus, the upper half of the human body corresponds to them. The last three correspond to Autumn and Winter, where qi descends and sinks; thus, the lower half corresponds to them. After the Light Snow solar term in the tenth month, marking the end of the six qi, Taiyang Cold-Water takes charge. For those exhausted by sexual activity and hard labor, the Taiyang Cold-Water qi enters the Foot Taiyang Bladder Meridian vacantly, due to resonance of similar qi. It is also said that Heat affects the head first, while Cold affects the feet first; this meaning is also valid. After Cold Evil accumulates for a long time, it transmits sequentially to Yangming and Shaoyang, and then to the three Yin meridians. Transmission always begins from the foot meridians and gradually extends to the hand meridians. This is the principle of the human body corresponding to heaven and earth, happening spontaneously. What is there to doubt?

Someone asked: The Sanjiao is a fu organ. Some consider the Pericardium (Xinbao Luo) as a zang organ, others consider the Mingmen as a zang organ. The Pulse Classic says: "Sanjiao has no form, existing only in name." Some say Sanjiao and Pericardium are fu and zang organs with names but no substance, located in the chest and diaphragm. Others say the Pericardium is the fatty membrane in the chest. Still others call it the meat surrounding the heart. These discussions vary. Which is wrong and which is right? Please