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(Zhang Jiebin wrote)

First is the condition of the patient. What is meant by the condition of the patient includes the constitution, such as each of the Zang organs having its own bias, and each of the Seven Emotions having its own overcoming relationship. Those with a Yang constitution are predisposed to favor coolness; those with a Yin constitution are predisposed to favor heat. For those tolerant of toxicity, mild treatment yields no effect; for those intolerant of toxicity, harsh treatment causes harm. This is due to differences in Zang Qi (Visceral Qi). There are those with preferences and aversions, whose dietary likes and dislikes not only extend to food but also affect their daily actions. Those who favor auspiciousness may reject alarming words; those prone to worry may view comfort as false. For the untrusting, sincere advice is hard to accept; for the suspicious, profound words invite resentment. These are differences in temperament. There are those from wealthy and noble backgrounds: the rich often act willfully, the noble often value their status. The willful consider themselves always right; true correctness may be seen as wrong. The self-important may treat scholars with disdain; those who value themselves would never demean themselves. These are differences in social interaction. There are those from poor and humble backgrounds: the poor cannot even ensure basic food and clothing, let alone medicine; the humble are burdened with anxiety and labor, making their state of mind understandable. These are differences in care and nursing. Furthermore, some may initially trust good advice but then adopt new fallacies, like losing sheep on many paths, ultimately achieving nothing—this is the harm caused by being leaderless and easily confused. Some fear unconventional methods, seeking only stability, like trying to extinguish a burning cart with a cup of water, preferring failure over risk—this is the harm caused by excessive caution due to inner fear. Some suffer from changes in fortune or deep emotional attachments, causing mental distress where mental illness cannot be cured by mental remedies—this is the harm caused by gains and losses. Some suffer from acute illnesses treated too slowly, or from frequent doctor changes leading to mixed medications, anxiously seeking speed which leads to rapid deterioration and death—this is the harm caused by urgency and slowness. Some are dogmatic, claiming their region does not benefit from tonification, thus harming those with deficiency; claiming their region does not benefit from purgation, thus harming those with excess. Even in ten households there are loyal and trustworthy people, so how can an entire village conform to custom? This is the harm caused by local customs. Some fear that entering Ren Shen (Radix Ginseng) or Bai Zhu (Rhizoma Atractylodis Macrocephalae) will cause chest stuffiness from tonification; they fear that touching Xiao Shi (Natrii Sulfas) or Da Huang (Radix et Rhizoma Rhei) will scatter their spirit from purgation. Like seeing a bow's reflection in a cup and fearing it is a snake, excessive suspicion is not a good method—this is the harm caused by preconceived notions. Some hide their illness and refuse to speak, eventually harming themselves; some hide their true feelings and dare not reveal them, making it impossible to obtain detailed information. However, some deliberately conceal their condition to test the doctor via pulse diagnosis. If the doctor happens to be correct, they are believed to be wise and capable; if incorrect, they are deemed mediocre. Who knows that there are only twenty-four common pulse types, while disease manifestations number in the hundreds or thousands? Therefore, one pulse does not correspond to only one disease, and one disease does not present with only one pulse. When pulse and disease correspond, such as a specific disease presenting with a specific pulse, it is auspicious; when they contradict, such as a specific pulse appearing with a specific disease, it is ominous. Although the principles of auspiciousness and ominousness reside in the heart, how can the variations of disease be fully described by pulse alone? Thus, knowing one, two, three, the sages earnestly taught the method of "San Wu" (interweaving and comparing). Being skilled, divine, and bright requires precision not just at the fingertips. The shallow views of laypeople are hardly surprising; yet even intelligent scholars often fall into this trap. Those who avoid inspection and listening find no color or sound to distinguish; those who dislike detailed questioning avoid speaking to prevent shame. By abandoning three of the Four Diagnostic Methods (Inspection, Auscultation-Olfaction, Inquiry, Palpation) for just one, and often failing to master even that one, it is impossible to understand the patient's condition. Thus, if communication is not established, the doctor is troubled by the patient; and if confusion and suspicion prevail, the patient troubles the doctor. All these are conditions of the patient that must be examined.

Second is the condition of bystanders. Bystander conditions involve rumors related to benefits and harms, where people often fail to restrain themselves. Some make arrogant claims that medical principles are mysterious and unfathomable. Others insist on seemingly evidence-based arguments, yet the actual condition is often erroneous and difficult to know. Some wield the power of right and wrong, agreeing with those like themselves and disagreeing with others, leaving true truth unknown to anyone. Some cling to superficial views, suggesting treating head pain by saving the head and foot pain by saving the foot, ignoring root and branch relationships as pedantic talk. In discussions between nobles and commoners, the noble's word prevails, forcing wise men to become yes-men. Among relatives and strangers, the relative's opinion dominates, forcing even competent doctors to retreat silently. Regarding doctor recommendations, which determine life and death, people are often careless. Some recommend based on minor coincidences, some out of personal favoritism, some swayed by eloquent speech, some by outward appearance—all lacking true understanding. Some recommend for greed, secretly seeking rewards; some out of personal connection, seeking other hopes. Some petty individuals, arrogant and flattering, cannot distinguish good from bad, praising thieves as saints and destroying phoenixes as owls, finding fault endlessly. True virtuous scholars are incompatible with such people. Though these individuals speak lightly without caring about joy or sorrow, their confusion of human sentiments is unparalleled. This often drives away skilled doctors and creates deep suspicion in patients' families. This is why right and wrong remain unclear for millennia, disturbed by mediocrities. Thus, those striving to handle affairs for others face great danger. All these are conditions of bystanders that must be examined.

Third is the condition of colleagues. Colleague conditions are particularly elusive and subtle. Those with narrow views are unworthy of mention; those with stubborn biases are not worth discussing. Some rely solely on eloquence, making baseless claims. They use clichés to deceive, sweet words to please, strong arguments to trick, or frightening words to scare, posing as gentlemen of investigation—these are the flatterers. Some focus on social connections, ignorant of classics, spreading hearsay, busy all day to sell themselves, flattering to please others—these are the sycophants. Some pursue novelty, ignorant yet claiming divine revelation or secret transmission, faking pulse readings to predict fortune, or playing tricks to disrupt norms—these are the frauds. Some focus on outward appearance, exaggerating, looking impressive but empty inside. Without inspecting color, listening to sound, or asking details, they prescribe after one pulse, claiming depth and clarity others lack—these are the reckless and careless. Some specialize in exclusion, pretending unity while plotting behind the scenes. While distinguishing right from wrong avoids hiding faults, especially in life-and-death matters, sincerity remains. But confusing right with wrong, overturning yin and yang, and fabricating misfortune out of ignorance or malice indicates lost conscience and jealousy—these are slanderous villains. Some are greedy and ignorant, despising human life. In critical cases, even gods might fail. One must not take rash risks, hoping only for recovery. Suddenly encountering such people who seek quick success through reckless prescriptions leads to disaster beyond repair. They then shift blame and attack verbally. Though colors may be confused, why should the innocent suffer? These are the greedy and ignorant. Those with different paths do not plan together, holding divergent opinions. Minor errors may be tolerated in light cases, but serious cases require precise treatment. Extraordinary diseases require extraordinary doctors; extraordinary treatments are unknown to ordinary people. Those who hear uniquely differ from the crowd; those who see uniquely do not fit in. High conduct invites much slander; high songs have few singers. Hence, one teacher cannot withstand the noise of Chu. Only when failure occurs do they disperse, too late for the few who remained. These are the presumptuous mediocrities. Some have grown accustomed to perfunctory compliance. They care little for the disease, focusing only on profit. Since patients don't understand medicine, they switch doctors frequently; since doctors refuse to bear responsibility, they use bland herbs like Ling Cao (Radix Glycyrrhizae) and Jie Geng (Radix Platycodi). When extending treatment costs, they watch each other; when interests conflict, they avoid suspicion. Thus, scratching doesn't relieve itch, beating doesn't cause pain. Doctors claim stability, which is indeed achieved, but at the cost of missing opportunities. This is because patients don't truly understand doctors, and doctors aren't fully trusted. As the poem says: "Words fill the courtyard, who takes the blame? Building a house by the road, it never gets done." These are common faults of patients and doctors today, too numerous to list. Striving for perfection leads to compromise. Compromise hinders treatment; non-compromise hinders human relations. How to handle situations where neither compromise nor non-compromise works? Those involved should examine these words and warn themselves. Not only will patient, bystander, and colleague conditions be managed without error, but preserving natural lifespan and reaching the realm of longevity will begin here. Only the wise will reflect on this.

Tao Hongjing said: When decocting soup, use low fire to keep it gently boiling. Water quantity follows the prescription. Generally, for twenty-four herbs, use one dou of water to boil down to four sheng, extrapolating from this. For purgative soups, keep them raw (light decoction), using less water to extract more juice. For tonic soups, cook them thoroughly, using more water to extract less juice, ensuring water amounts are appropriate. Use fresh cloth and a wooden roller operated by two people to squeeze, clarify to remove turbidity, cover with paper tightly. Do not use iron vessels for warm soup. Soup should be gently boiling; hot is easy to swallow, cold causes vomiting.

Li Shizhen said: Tao's description is ancient method. Modern small prescriptions use two ou of water per liang of herb. Add if needed, reduce if less. Too much herb with little water prevents extraction; too little herb with much water dissipates medicinal power. When decocting, avoid copper and iron vessels; use silver or clay pots, clean and sealed, watched carefully. Master the fire, neither too strong nor too weak. Wood charcoal or reeds are best for fuel. Water should be freshly drawn and sweet-tasting. Running water, well water, or boiled water follow specific methods. For diaphoretic medicines, use strong fire and serve hot. For purgatives, use strong fire to boil, add Xiao Shi (Natrii Sulfas) and Da Huang (Radix et Rhizoma Rhei), then boil again and serve warm. Tonics should be slow-decocted and served warm. Acute cold-yin diseases should also be fast-decocted with strong fire. For cold-dysphoria or summer internal cold, serve chilled by sinking in cold water.

Sun Simiao said: The roots of hundred diseases include Wind Stroke, Cold Damage, Cold-Heat, Warm Malaria, Evil Strike, Cholera, Abdominal Edema, Intestinal Discharge, Diarrhea, Urinary/Fecal Obstruction, Rebellious Qi, Cough/Reverse Qi, Vomiting, Jaundice, Wasting-Thirst, Retained Fluids, Accumulated Food, Hard Accumulations, Masses, Startling Evil, Epilepsy, Ghost Tethering, Throat Bi, Toothache, Deafness, Blindness, Metal Wounds, Fractures, Carbuncles, Malignant Sores, Hemorrhoids, Tumors/Cysts, Men's Five Exhaustions and Seven Injuries, Deficiency and Emaciation, Women's Leukorrhea, Metrorrhagia, Blood Obstruction, Genital Erosion, Gu Poison/Snake Venom. These are general categories; variations depend on specific clues. Also included are Cold-Heat Exhaustion, Overeating, Sexual Exhaustion, Palpitations, Fear, Anxiety, Alarm, Childbirth, Miscarriage, Postpartum Stasis, and indulgence in Five Minerals for sexual pleasure. These are root causes generating branch symptoms; one must know origin and outcome. When consulting doctors, half of descriptions by men, women, young, and old may conflate with disease sources, yet medication is prescribed. Men are gathering places of Yang, often dry. Yang qi moves freely; forceful release causes exhaustion. Injury diseases are numerous. Compared to women, they are ten times harder to treat. Women above fourteen have menstruation. On menstrual days, exposure to wind, cold, damp, heat, or seasonal pathogens causes illness; they should describe it themselves. Otherwise, treatment errors increase suffering. Prescribers should ask.

Sun Simiao said: Recently, rural families buy herbs and hire millers, often improperly. For hard-to-pulverize herbs like Shi Hu (Dendrobii Caulis) and Tu Si Zi (Cuscutae Semen), millers steal and discard parts to save effort. Dust and foul air enter the powder, which is sifted roughly and blown away. Tasted by many, smelled by many, the essence is lost, resembling rotten wood. Patients then fail to take them correctly, worsening deficiency, and blame doctors for ineffectiveness. This is not the doctor's fault but the patient's misguided intent; reflect carefully.

Yu Huazi said: Knowing evil thoughts is awareness. Cutting off evil thoughts is non-continuation. Illness has causes. Knowing the cause, guard against it before it arises; removing the cause prevents recurrence, which is the merit of healing. Awareness of cutting thoughts comes from non-continuation. Each time aware, each time removed; if not continued, it ends. Thus: fleeting desire is disease; non-continuation is medicine.

Zhang Dafu said: Killing things to cure disease is inferior to preserving life to cure. My uncle had measles. My grandfather sought stork eggs to treat it. Getting them, the stork chased its egg and fell dead. Grandfather mourned: "Seeking life through dead offspring, but harming living eggs—how contradictory!" He abandoned it. By midnight, measles healed. If eating eggs cured it, people would credit the egg. The stork's egg hatching isn't the stork's doing, but life isn't proven by eggs; this solves worldly confusion. I often suffered palpitations. A doctor advised eating soft-shelled turtle, saying blood nourishment cures palpitations. After a month, palpitations persisted. One night, I dreamed turtles biting me from neck to arm, skin torn. Waking with pounding heart, palpitations worsened. Alas! Some kill to worsen disease.