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Zhang Zhongjing said: Heaven distributes the Five Elements (Wu Xing) to operate all categories of things, and humans receive the Five Constants (Wu Chang) to possess the Five Zang Organs. The meridians (Jing Luo) and fu-shu acupoints are where Yin and Yang intersect and communicate. Their principles are profound, obscure, subtle, and mysterious, with changes that are difficult to exhaust. Unless one possesses high talent and exquisite insight, how can one explore their rationale? In ancient times, there were Shennong, the Yellow Emperor, Qibo, Bogao, Leigong, Shaoyu, Shaoshi, and Zhongwen; in the middle ages, there were Changsang Jun and Bian Que; in the Han Dynasty, there were Gongcheng, Yang Qing, and Cang Gong (Chunyu Yi). Since then, few have been heard of. Observing contemporary physicians, they do not ponder and seek the essence of the classics to expand their knowledge. Each inherits family techniques, consistently following old methods. When examining illnesses and asking about diseases, they strive only for eloquence. After a brief conversation, they immediately prescribe decoctions. They palpate the Cun (inch) position but neglect the Chi (cubit) position; they grasp the hand pulse but neglect the foot pulse. They do not compare the Renying (Carotid artery) and Fuyang (Dorsalis pedis artery) pulses with the three positions. The pulse beats rapidly, yet the respiration count is less than fifty (indicating insufficient diagnostic time). They cannot determine prognoses regarding life and death, and the Nine Palpations (Jiu Hou) offer no clarity. They fail to observe the Ming Tang (nose), Que Ting (glabella and forehead), which is like looking at the sky through a tube. To distinguish between life and death is truly difficult. Confucius said: Those who know from birth are superior; those who learn are next. Those who hear much and know widely are below that. I have long esteemed medical arts; please let me follow these words.

Sun Simiao said: Medical prescriptions, divination, and casting are skills difficult to master. Since they are not divinely bestowed, how can one grasp their subtleties? There are foolish people in the world who read prescriptions for three years and claim there is no disease that cannot be cured; yet after treating patients for three years, they realize there are no ready-made prescriptions available. Therefore, students must extensively explore the sources of medicine, being precise and diligent without weariness. As for those who claim to be physicians based on hearsay, do they not deeply mislead themselves?

Shi Hong said: For a physician, reading books is key. There have been those who read but could not become good physicians, but never one who did not read and could become a physician. Not reading medical books, nor coming from a hereditary medical family, killing people would be far worse than using sticks or blades.

Dai Shuneng of Jinhua said: Physicians aim to save lives, which is closest to the Way of the Confucian scholars. Since the Tang Dynasty classified medicine under "skills," Confucian scholars have disdained it. Contemporary practitioners merely recite one school's theories and adhere to fixed formulas, hoping for accidental success; they do not delve deep or search far, nor do they seek the intentions of sages to understand the convergence of Yin-Yang and creation. Nor do they extensively read various books and adopt diverse opinions to aid in flexible treatment strategies. Worse still, some discard ancient formulas, force interpretations based on subjective views, leading to confusion and significant harm. Is this the original intention of sages to show compassion and benefit the people?

Scholar Shang Lu said: Medicine relies on intuition/mind (Yi). It is like a general facing an enemy or a boatman navigating; agility in adapting to circumstances is prized. Formulas are indeed hard to apply universally, yet without them, the minds of the ancients cannot be transmitted, leaving one茫然 as if gazing at the ocean or catching wind, inevitably leading to arbitrary errors. Can formulas really be unused? Although formulas are good, one must thoroughly study the *Suwen* (Plain Questions) to seek the root, the *Bencao* (Materia Medica) to investigate usage, diagnosis to observe syndromes, and treatment to understand variations. Starting with using formulas, one eventually reaches a state where reliance on formulas is unnecessary; only then is the Way of Medicine perfected. Xu Yizong once said he was good at reading Zhang Zhongjing's works and understanding their intent, yet never strictly applied his formulas. This is truly a profound statement.

*Xu Yishuo* records: Recent physicians are biased by their own views. Some prefer hot medicines, others cold medicines. However, the *Suwen* contains the "Treatise on Different Methods and Appropriate Prescriptions," showing no bias. Ancient excellent physicians always assessed the deficiency or excess of the patient and the Yin-Yang nature of the disease before prescribing decoctions. Tonification or purgation followed the syndrome. If it was clearly Yang deficiency with blood loss, treat with Gan Jiang (Dried Ginger) and Fu Zi (Aconite Root); for various deficiencies and damages, tonify with Ren Shen (Ginseng) and Huang Qi (Astragalus); for phlegm-heat obstructing cough, clear with Huang Qin (Scutellaria) and Lian Zi (Coptis); for constipation with heat, purge with Xiao Shi (Mirabilite) and Da Huang (Rhubarb). Are these methods abandoned? Xu Shuwei said: If the form has cold pathogens, even infants can take Jin Ye Dan (Golden Liquid Pill); if the viscera have heat toxins, even the elderly and frail can take Da Huang (Rhubarb). How comprehensive and adaptable this view is!

Yang Renzhai said: Treating disease is like steering a boat. With the rudder in hand, during stormy waves, any shift causes capsizing. The physician's judgment must be firm; one must not blindly comply with the patient's family's desires. One must not panic, causing the patient alarm. If the family has superficial knowledge and argues repeatedly, do not be confused. Also, if symptoms recur after recovery due to taboo violations, concealment must be questioned to treat appropriately.

Lu Xuan Gong argued: Physicians take saving lives as their heart; thus, medicine is the Art of Benevolence (Ren Shu). Seeking medical help is like crying out for rescue from fire or drowning. Medicine is a benevolent art; one must rush to save them, hair disheveled and cap askew. Otherwise, if delay leads to scorching or drowning disasters, can anyone with a benevolent heart endure it? I privately see physicians taking advantage of urgency to extort wealth; this is pursuing profit like Zhi (a bandit), not the Art of Benevolence. This is worse than incompetence. Will Heaven not punish them? Now, seeing descendants of physicians often enjoy residual blessings and rise to high positions, this is proof of Heavenly retribution. Why calculate temporary profit while destroying benevolence and righteousness, opposing the Way and violating the Heavenly Principle of nurturing life? Practitioners should beware!

Physicians should reflect: Human suffering is no different from my own. Upon summons, go quickly without delay. If only medicine is requested, dispense it immediately. Do not ask about status or select by wealth. Focus solely on saving lives; in the unseen realm, there will be protectors. Taking advantage of urgency to seek wealth implies un-benevolent intent; in the unseen realm, disaster awaits. My hometown had Zhang Yanming, skilled in medicine. He treated monks, Daoists, poor scholars, soldiers, and the poor without charge, sometimes giving money and grain. He visited the poorest without hesitation. For the rich, regardless of payment amount, he provided ample medicine, aiming for cure, never expecting return payment. For critical cases, he gave good medicine to comfort them, refusing payment. I knew him well; he never spoke of money while practicing, making him the foremost among physicians. Once, a city fire burned everything around, yet his house stood alone in the smoke and flames. A year later, a cattle plague devastated the area, but his estate remained intact. This was divine assistance. His son studied and passed the imperial examinations with top honors. His grandsons were robust and handsome, confirming Heaven's blessing on the virtuous. If he had pursued wealth, he would have lost these blessings; gains would not compensate losses. Fellow practitioners, beware!

Sun Simiao said: For patients with sores, ulcers, or dysentery, whose foul odor is repulsive to others, the physician must feel pity and care, without aversion or reluctance. This is my aspiration.

Sun Simiao said: The rules for physicians include: do not talk excessively or laugh, make noise, gossip, discuss others' affairs, boast of fame, slander other physicians, or pride oneself on virtue. Accidentally curing one disease and then acting arrogant, claiming uniqueness, is the fatal flaw of physicians.

Sun Simiao said: When visiting a patient's home, even if surrounded by silk and brocade, do not look around. Even if music fills the ears, do not entertain yourself. Even if delicacies are served, eat as if tasteless. Even if beauties are present, ignore them. Why? Because if one person is sad, the whole hall is unhappy. How much more so when the patient suffers constantly? If the physician remains happy and proud, it is shameful to spirits and unacceptable to sages.

Laozi said: Those who perform positive virtue receive repayment from others. Those who perform hidden virtue are favored by ghosts and gods. Yin-Yang retribution is not false. Therefore, physicians must not rely on their skills to greedily acquire wealth. Only by harboring a heart to relieve suffering will one receive abundant blessings in the unseen realm.

Qian Yi, during Emperor Shenzong's reign, treated Crown Prince Yi Guo Wang's convulsions. Imperial physicians could not cure him. Qian Yi prescribed Huang Tu Tang (Yellow Earth Decoction), and the prince recovered. Shenzong asked: Why did Huang Tu Tang cure this illness? Qian Yi replied: Earth overcomes Water; Wood achieves balance, so Wind stops naturally. Moreover, other physicians were close to curing him; I merely happened to coincide with his recovery. Shenzong was pleased and rewarded him generously.

Cheng Huang Dun said: Recent scholars with reputations dismiss Li Dongyuan and Zhu Danxi's works as unworthy. They say: These two constantly cite the *Suwen* and *Nanjing*, just as Confucians cite the eras of Tang, Yu, and the Three Dynasties—what use is it? Alas! Such statements are extremely perverse.

Tan Jingsheng's *Huashu* says: Those who praise others are praised. Those who slander others are slandered.

Mr. Zhu Danxi taught his ten sayings to his sons. One said: Among colleagues, be humble and harmonious; do not be arrogant. Respect elders. Treat learned individuals as teachers. If medical opportunities arise, yield righteously; do not snatch them, causing resentment and slander. The Classics say: In the application of propriety, harmony is precious.

*Bozhai Bian* records: Scholar Wang Ju'an suffered from hemorrhoids for a long time. Hearing of a skilled practitioner in Xiaoshan, unable to invite him due to lack of funds, he took a boat from Wucheng to Qiantang, stayed in a quiet residence, and sent someone to fetch the doctor. The doctor crossed the river to Hangzhou. Upon meeting, he happily treated him with herbs, saying: Give me five days, and I can eradicate the root. First, a medicine lowered the rectum several inches. Then, another medicine washed it. Slowly, he tied the hemorrhoid with a medicinal thread. After two nights, the hemorrhoid fell off, size of a peach. He then used herbal tonics, and within days, the patient was stable. The doctor showed no difficulty initially, discussing fees only after reducing the prolapse. Knowing his life hung in the balance, the patient promised all his belongings as reward, allowing treatment. Another case: Zhou Jin from Yushan, adjusting office in the capital, suffered from bladder qi and unilateral testicular swelling. A traveling medic claimed he could stop it in a brief conversation, demanding 10,000 coins and three bolts of silk. Entering the room, he inserted one needle, and the pain ceased. Zhou was delighted and paid immediately. Half a month later, the disease returned. Sending people to find the doctor, he was gone. Ancient worthies sometimes practiced medicine or divination. Modern physicians, eager for fame and profit, often use deceitful means to exploit the public, akin to thieves with knives. I witnessed these two events and record them as a warning to the world.

*Shen Zhi* records Monk Fazheng of Wenzhou, courtesy name Wuwang. Blind since youth, treatments failed. He chanted the name of Avalokitesvara Bodhisattva day and night for fifteen years. In a dream, the Bodhisattva called him forward, holding his feet immobile. The Bodhisattva sighed: In your past life, you were a moxibustion practitioner who accidentally damaged someone's eyes. You must bear this retribution now, hard to escape. But pitying your sincerity, I ensure you abundant food and clothing. She gave him handfuls of pearls from her bosom. Upon waking, his medical practice flourished, and he became wealthy. He lived to seventy.

*Szhi* records Duan Chengwu from Yixing, highly skilled in medicine but greedy for wealth. Only powerful figures could compel him to visit. Duke Zhi Zhonghui in Changshu wanted to see him but couldn't, eventually inviting him via Governor Liang of Pingjiang. Returning to Pingjiang, a rich man sought his help. Duan said: This needs only a few doses of decoction, but requires 500,000 cash as thanks. The family offered half. Duan left in anger. Eventually, he accepted, taking 50 taels of silver for medicine costs. He demanded up to 100 taels before prescribing. Cured in days, he returned west with his earnings. At night, he dreamed of a figure in red robes saying: The Emperor appointed you a physician, yet you greedily take bribes, lacking compassion. Order twenty strokes on the back. He felt the blows upon waking and saw marks on his skin. He died shortly after returning home.

Assistant Fu from Fulizhen, Xuancheng, treated carbuncles and sores with malicious intent. For a mild sore, he first applied irritant drugs. Suddenly, a yellow-robed messenger appeared, showing a paper: The Underworld pursues you. He struck Fu's back with a rattan cane. Fu screamed in pain. The messenger said: So you know pain too. Fu developed a massive carbuncle and died.

*Myi Lu* records: A woman in the capital, surnamed Bai, beautiful, known as "White Peony," sold abortifacients. She developed severe headache and swelling, untreatable by famous doctors. It ulcerated, smelling foul. She cried out nightly, heard far and wide. One day she told her family: Burn all my abortion formulas. Warned her children: Vow never to transmit this trade. Her son asked: Mother, we built our fortune on this, why abandon it? She said: Every night I dream of hundreds of babies sucking my brain, causing pain and screaming. This is the retribution for using poison to destroy fetuses. She died speaking.

*Yishuo* records Physician Lu Yang, courtesy name Yiruo, from Shuiyang Village, Xuan Guan, known for skill. During Jianyan era, wife of Editor Zhu Cuilao fell ill from fear and anxiety fleeing bandits. Lu Yang mistakenly prescribed Xiao Chai Hu Tang (Minor Bupleurum Decoction), killing her. Later, Li's son from Gachun Town, Lishui, summoned him for consumption (tuberculosis). Medicines failed. Lu drank with prostitutes, demanded money and food. Denied, he administered dozens of harsh pills, killing him again. In the ninth year of Shaoxing, Lu fell suddenly ill, shouting: Zhu Yiren, Li Liulang, stop beating me, I'm leaving! He died ten days later.

The Yellow Emperor said: There are twelve meridians and 365 collaterals, known to all and used by practitioners. Failure to achieve perfection arises from lack of mental focus, disordered will, and external interference, leading to doubt and danger. Not knowing the principles of Yin-Yang and reversal/adherence is the first error in treatment. Incomplete apprenticeship, practicing random arts, falsely claiming Dao, renaming oneself for merit, and recklessly using needles and drugs, bringing blame upon oneself, is the second error. Ignoring differences in poverty, wealth, status, lifestyle thickness/thinness, physical cold/warmth, and dietary suitability; failing to distinguish courage from timidity; lacking analogical reasoning, leading to self-confusion rather than clarity, is the third error. Diagnosing without asking about the onset, stress, dietary irregularities, excessive起居 (daily routine), or toxic injuries; suddenly palpating the Cun position without context, guessing names, and being trapped by coarseness, is the fourth error.

The Yellow Emperor said: In diagnosing, one must ask if the patient was formerly noble and now lowly. Even without external pathogens, internal disease arises, named Tuo Ying (Depletion of Vitality). Formerly rich, now poor, named Shi Jing (Loss of Essence). Five Qi stagnate, diseases combine. Physicians diagnose, finding nothing in Zang-Fu or body shape. Diagnosis yields doubt, unknown disease name. Body wastes away, Qi becomes empty, Essence depleted. Deep disease lacks Qi, shivering with sudden fright. Deep disease involves external depletion of Wei Qi and internal deprivation of Ying Qi. Excellent physicians err by not understanding the condition; this is the first fault. In diagnosis, one must ask about diet and dwelling. Sudden joy or sorrow, starting with joy ending in sorrow, all damage Essence and Qi. Essence and Qi exhaustion destroys the form. Violent anger injures Yin, violent joy injures Yang. Rebellious Qi ascends, filling vessels and separating from form. Foolish physicians do not know tonification or purgation, nor the condition. Essence depletes daily, pathogenic Qi combines. This is the second fault. Those skilled in pulse-taking must use analogy and comparison with unusual patterns, calmly understanding. Practitioners unaware of this are unworthy. This is the third fault. Diagnosis has three constants: ask about status. Loss of power by nobles, even without pathogens, causes internal spiritual injury and bodily collapse. Wealth turning to poverty, even without pathogens, causes dry skin, protruding tendons, flaccidity, and contracture. Physicians unable to be strict or move the Spirit, appearing weak externally, losing order, cannot move the disease; medical practice fails. This is the fourth fault. All diagnosticians must know beginning and end, having additional insights. Pulse-taking and questioning names must match gender. Separation, depression, worry, fear, joy, anger cause Zang emptiness and Qi/Blood dispersion. If practitioners do not know this, what technique is there? Former wealth greatly damaged, sinews cut, vessels severed, body moves but luster ceases, injury accumulates, thinness returns to Yang, pus collects with cold/heat. Crude physicians urgently puncture Yin/Yang. Body dissolves, limbs cramp, death date approaches, physicians cannot clarify. Not asking origin, only stating death date, makes one a crude physician. This is the fifth fault. All five result from incomplete learning and ignorance of human affairs.

*Rites of Zhou*: The Physician-in-Chief manages medical orders, gathering poisonous substances for medical affairs. For subjects with diseases or sores (head sores called Kan, body sores called Yang), physicians treat them separately. (Order refers to gathering poisons/drugs for treatment. Command refers to assigning physicians. Poisons refer to drugs. Hardship refers to sores. Separate treatment means each physician has specific expertise. Drugs vary in toxicity. Non-toxic drugs treat disease; toxic drugs induce disease. Drug properties change with seasons. Mineral properties depend on Five Elements concentration. Types differ, natures are biased. Humans get sick from biases of Yin-Yang and cold/heat. Disease arises from bias; medicine uses bias. They must attack each other to complement. Misuse makes non-toxic drugs toxic. Physicians must know drug toxicity and act cautiously. Understand Sovereign, Minister, Assistant, Courier roles; adjust warm/cold/dry/damp suitability; examine exterior/interior, vomiting/purgation methods; comprehend Creation and Life principles. Then, though toxic, they are not toxic. Hence, gathering poisons is primary, emphasizing importance.)

At year-end, medical performance is reviewed to determine salary. Perfect cure rate is superior. One failure in ten is next. Two failures in ten is next. Three failures in ten is next. Four failures in ten is inferior. (Review means calculation. Salary means emolument. Perfect means ten cures out of ten. Failure means ineffectiveness. Four failures is inferior, meaning lowest salary. Five failures results in dismissal without salary. Heavy punishment emphasizes the value of human life, incomparable to other posts.)

Physicians of Diseases manage the health of the myriad people. Epidemics occur in all four seasons. Spring has head pain diseases, summer has itching/scabies diseases, autumn has malaria/chills diseases, winter has cough/asthma diseases. (Heaven has Six Qi: Yin, Yang, Wind, Rain, Obscurity, Brightness, all capable of injuring form. Humans have Six Diseases: Cold, Heat, Limb, Abdomen, Confusion, Heart, all capable of injuring Qi. Circulating in Ying and Wei, flowing through limbs. Communication brings harmony; excess or deficiency brings disease. If nourishment is improper and coincides with these, Qi diseases attack, severely leading to illness. This Physician of Diseases speaks of "nourishing" in treating disease, precisely observing the roots of Six Diseases and adapting to Six Qi movements, representing excellent physicians. Epidemic diseases are disorders of Qi harmony. Sour/numbness. Head pain is headache. Cough is coughing. Upper Qi is reverse asthma. In four seasons, winter injury to Cold, Yang dominates internally. Spring Wood governs, Yang emerges externally, then Cold Qi combats it, causing head pain. Spring Wood is Liver, governing color. Fire exceeds in Summer, child surpasses mother, so Summer Heat overflows causing scabies/itching. Summer injury to Summer Heat, Yin dominates internally. Autumn Metal governs, Yin emerges externally, then Summer Heat combats it, causing malaria/chills. Autumn Metal is Lung, governing sound. Water exceeds in Winter, child surpasses mother, so Cold Qi obstructs causing cough/upper Qi disease. These four are imbalanced Qi of four seasons, hence called epidemics.)