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Using the Five Flavors (sour, bitter, sweet, pungent, salty), Five Grains (hemp, millet, broomcorn millet, wheat, soybean), and Five Medicinals (herbs, trees, insects, minerals, grains) to nourish and treat the patient's illness, one judges life and death by observing the Five Qi (liver warmth, heart heat, spleen harmony, lung coolness, kidney cold), Five Sounds (shouting, sighing, singing, weeping, groaning), and Five Colors (green, red, yellow, white, black). This is combined with the changes in the Nine Orifices (eyes, ears, nostrils, mouth, anterior and posterior orifices) and referenced against the movements of the Nine Zang Organs (the five regular Zang plus stomach, bladder, large intestine, small intestine). (The Five Flavors refer to vinegar, wine, maltose, honey, ginger, salt, etc. The Five Grains refer to hemp, foxtail millet, broomcorn millet, wheat, and soybeans. The Five Medicinals refer to herbs, trees, insects, minerals, and grains. "Nourish" here implies treatment. If pathogenic Qi is excessive, causing deficiency of healthy Qi, attack methods are used; if healthy Qi is deficient, nourishing methods are employed. The Five Qi refers to: liver Qi being warm, heart Qi being hot, spleen Qi being harmonious, lung Qi being cool, and kidney Qi being cold. The Five Sounds refers to: liver sound as shouting, heart sound as sighing, spleen sound as singing, lung sound as weeping, and kidney sound as groaning. The Five Colors refers to: liver color green, heart color red, spleen color yellow, lung color white, and kidney color black. These three manifestations of drastic change appear externally. Observing their fullness, emptiness, and prosperity allows one to know auspiciousness or inauspiciousness. Among the Nine Orifices, there are seven Yang orifices: two ears, two eyes, two nostrils, and one mouth; and two Yin orifices: the anterior and posterior orifices. Orifices refer to those that have form and are visible externally. "Two" refers to Yin and Yang; "change" refers to the transformation of Yin and Yang. By observing the changes in symptoms, one can discern the two states of unobstructedness and obstruction. Among the Nine Zang, there are five regular Zang: lung, heart, liver, spleen, and kidney, plus four from the Fu organs: stomach, bladder, large intestine, and small intestine. Zang refers to those that have form and are stored internally. "Reference" refers to the relationship between Yin/Yang and Chong Qi. By observing pulse movement, one can distinguish the three positions: floating, middle, and deep. In summary, the Nine Zang do not exceed the scope of the Five Zang, yet connect superiorly to the Nine Orifices. By mastering the essentials through "two" and "reference," the five nourishing methods can be applied correctly, and the physician will avoid errors.)

For common people suffering from diseases, they are treated separately. Upon death, the cause is recorded and reported to the physician. (Death at a young age is termed "si"; death at an old age is termed "zhong." "So yi" refers to the state where disease treatment failed, leading to death. Reporting to the physician allows for determining remuneration and serving as a warning for the future.)

Physicians specializing in sores (Yang Yi) manage external applications for swelling sores (accumulation leading to ulcers), ulcerative sores (abscesses containing pus and blood), metal wounds (blade injuries), and fracture wounds (falls/injuries). (Swelling sores involve qi and blood stagnation forming surface lesions. Ulcerative sores are abscesses ruptured with pus and blood. Metal wounds are injuries caused by blades. Fracture wounds are traumatic injuries. "Zhu" is a variant for "zhu" (apply), meaning applying medicine to the lesion. "Li" means scraping away pus and blood. "Sha" means using medicine to corrode and remove necrotic tissue.)

In treating sores, use Five Poisons (toxic medicines) to attack the pathogen, Five Qi to nourish the body, Five Medicinals to treat the disease, and Five Flavors to regulate diet. ("Liao" means to stop the disease. Five Poisons refer to five types of toxic medicines. Current medical formulas include Five Poison medicines, made by mixing realgar, bismuth ore, cinnabar, alum, magnetite, burning them for three days and nights. The smoke deposits on objects, which are collected with chicken feathers and applied to wounds, causing necrotic tissue to fall off. "Li" means scraping away bad blood. "Sha" means eroding evil flesh. Generally, swelling should be dispersed, ulcers healed, injuries restored, and fractures continued. Thus, one must first attack with Five Poisons, then nourish with Five Grains, treat with Five Medicinals, and regulate with Five Flavors.)

Medicines: Sour flavor nourishes bone, pungent flavor nourishes tendon, salty flavor nourishes vessel, bitter flavor nourishes qi, sweet flavor nourishes flesh, and slippery substances nourish orifices. Those with sores receive these treatments. (This speaks of mutual nourishment by category. Sour belongs to Wood; wood roots standing in earth resemble bones. Pungent belongs to Metal; metal binding foreign objects resembles tendons. Salty belongs to Water; water flowing in earth resembles vessels. Bitter belongs to Fire; fire entering and exiting invisibly resembles qi. Sweet belongs to Earth; earth carrying four elements resembles flesh. Slippery refers to talc. Various slippery things facilitate flow, resembling orifices. Treating sores focuses on bone, but tendons, vessels, and qi must not be excessive; medication should be moderate.)

Tao Hongjing said: Ordinary physicians today are ashamed to consult Materia Medica. Some rely on copying old formulas, some on hearsay, some on memory, and hastily write prescriptions. They then wear hats to display their uniqueness. Their aversions contradict their needs, resulting in ignorance. Drug categories deviate from norms, dosages vary inconsistently, yet they do not doubt it. If by chance a cure occurs, they claim efficacy. If no improvement after a month, they blame deep-seated pathology, never reflecting on their own errors. They fabricate reputations and extort money. This deserves condemnation among the living and punishment in the underworld.

Zhan Zhan said: The difficulty of mastering classic formulas has existed since ancient times. Diseases may share internal similarities but present differently externally, or vice versa. Therefore, the fullness or emptiness of the five Zang and six Fu organs, and the patency or blockage of blood vessels and Ying/Wei, cannot be perceived by eyes and ears alone; diagnosis is required. Pulse positions (Cun, Guan, Chi) show floating, sinking, wiry, or tight variations; acupoint flows differ in depth and level; skin, muscle, bone, and tendon vary in thickness and texture. Only those with refined minds can discuss this. Using coarse thinking for subtle matters is dangerous. Tonifying excess, purging deficiency, obstructing blockage, or stagnating cold only worsens the condition, leading to death.

Sun Simiao said: Ancient and modern disease names often differ, causing confusion during emergencies. Without clarification, how can one instruct others? For instance, "Yin Du Shang Han" is considered severe. However, the name "Yin Du" implies Sha Yin syndrome, while the pathology involves Yin-Yang patterns. Naming one disease involving three categories leads to confusion. Yin Du, Sha Yin, and Yin-Yang are distinct patterns requiring different treatments. Ancient texts clarify this; modern confusion harms patients. Terms like Chang Feng, Zang Du, Ke Ni, Man Jing lack standard definitions. Chang Feng is hemorrhoids bleeding; Zang Du is dysentery toxin; Ke Ni is hiccups; Man Jing is yin epilepsy. One must know both ancient and modern terms to save lives. Classic formulas use obscure terms: "Li" for dysentery, "Jue" for beriberi, "Lin" for strangury, "Shi" for constipation, "Tian Xing" for epidemic cold, "Bai Hu" for rheumatic arthritis, "Ge Qi" for critical illness, "Chuan Sou" for cough, "Jiang Zhi" for spasm, "Bu Yu" for aphonia, "Huan Zong" for flaccidity, "Zheng Song" for palpitations, "Tan" for fluid retention, "Huang" for jaundice. Such discussions are essential. Moreover, similar symptoms may have different names, or different symptoms share names. Today, doctors indiscriminately label wind-stroke, heat disease, and plague as "Shang Han"; edema, drum distension, intestinal tumors, and uterine masses as "water qi." Treating wind-stroke with phlegm-resolving drugs or misidentifying dysentery as consumption are common errors. I clarify these distinctions.

As the saying goes: "If not a wise chancellor, then a skilled physician," highlighting the difficulty of medicine. Errors include: 1. Using cooling drugs for deficiency, popularized by Danxi, who claimed yang is always excess and yin always deficient. Using Anemarrhena and Phellodendron for "nourishing yin" often damages spleen yang over time. 2. Improper processing: Soaking ginseng in child's urine contradicts materia medica warnings against salt and urine. Processing Aconite with urine destroys its potent nature, akin to weakening a general before battle. 3. Misidentification: Confusing Qing Pi with immature bitter orange, Shi Gao with calcite, or Gou Qi Zi with Di Gu Pi. 4. Arbitrary prescribing: Modern doctors often use bland, ineffective formulas without careful consideration, unlike ancients who used precise classic formulas like Si Jun Zi Tang. Medicine is like war; misuse kills.

Wang Zhongwen noted: Li Dongyuan's lineage spread in the Central Plains, while Liu Wansu's teachings passed through Daoist masters to Luo Zhiti in the South, becoming dominant in the Ming Dynasty. Liu and Li differed in attacking vs. tonifying, but integrating them suits various conditions. Wu doctors pride themselves on following Dongyuan or Zhang/Liu. However, rigid adherence is flawed. As Sun Simiao said, formulas must adapt to circumstances.

Wang Wenke stated: Modern doctors follow Li Dongyuan and Zhu Zhenheng, relying heavily on Ginseng and Atractylodes. While this represents the "Kingly Way" of medicine, diseases change, requiring formula adjustments. Rigid adherence leads to failure; slight deviations accelerate death. One must understand flexibility ("Quan").

Kong Ziyue warned: Plants and animals vary by region and season. Local substitutes often fail. Deceiving commoners is bad; deceiving rulers is a grave sin.

Chen Jiamo cited proverbs: Sellers of medicine have one eye, users two, patients none. Adulteration is rampant: fake dragon bone, musk mixed with lychee pits, horseradish instead of costus, donkey tendon as tiger bone. Such fraud harms patients and brings karmic retribution.

Tao Hongjing's biography recounts his disciple Huan telling him that using leeches and horseflies in his Materia Medica harmed life, delaying his ascension. Tao subsequently wrote a supplementary text using plant substitutes to atone.

Xu Yinzong argued: Pulse diagnosis is subtle and hard to verbalize. Ancient masters used single herbs for pure effect. Modern doctors use multiple herbs hoping for luck, diluting efficacy. He refused to write books because pulse wisdom cannot be transmitted via text.

The *Taiwei Xianjun Gongguo Ge* assigns merit/demerit for medical acts: saving lives earns merit; taking bribes nullifies it; harming others incurs heavy demerits. The *Great Ming Code* penalizes negligent or fraudulent medical practice severely, including execution for intentional harm.

The *Qiao Tan* concludes: Killing by sword carries the death penalty, but killing by medicine, military command, or tyranny often escapes legal justice, questioning the fairness of law.