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Mr. Li Dongyuan said, "From Fuxi, Shennong, and the Yellow Emperor onwards, although there have been many famous physicians, how many are truly worthy of emulation? As for Hua Tuo's (Hua Shi) abdominal surgery or Wang's (Wang Shi) miraculous acupuncture techniques, while their skills were indeed profound, how could later generations hope to replicate them? This is not comparable to the classic works of Qibo, the processing methods of Leigong, the decoctions of Yi Yin (Yi Fangzhi), the *Hongfan* of Jizi, the dialogues of Bian Que (Yueren), Zhang Zhongjing's *Treatise on Cold Damage*, Wang Shuhe's *Pulse Classic*, Huangfu Mi's (Shi'an) *Jia Yi Jing*, Wang Bing's (Qixuanzi) commentaries, Qian Yi's (Qian Zhongyang) discussions, Zhang Yuansu's (Jiegou) formularies, and others. These are all living methods that can be learned by people. How can they be compared to those myriad formulas and theories that merely fix the eyesight and thinking of later generations? Among them, those with high virtue and far-reaching conduct, extraordinary talents, whether holding official positions or hiding in the wilderness, may have certain merits worth observing. However, if they do not represent living methods applicable for a hundred generations, they are not adopted. Do I enjoy debating? No, I simply wish for students to observe these sages and know whom to admire. If someone merely reads widely and recites generally, considering themselves well-learned, yet finds no utility in practice, do they truly understand the root?"

Someone asked Mr. Zhu Danxi (Zhu Yanxiu): "Regarding medicine—taking pulses, examining diseases, and prescribing herbs—why do you insist that only those who study Confucian classics can excel?" He replied: "Without the *Four Books*, one cannot exhaust principles and fully realize human nature, achieving the merit of investigating things to extend knowledge. Without the *I Ching* (*Book of Changes*), one cannot exhaust the functions of yin-yang creation and transformation, the laws of waxing and waning, generation and destruction, and the principles of ascending and descending, floating and sinking. Sun Simiao said: 'One who does not know the *I Ching* is unfit to be called a Grand Physician.'"

Another asked: "Which medical books should be read first?" The reply was: "One must first read the *Neijing* (*Inner Canon*), *Bencao* (*Materia Medica*), and *Maijing* (*Pulse Classic*). Without the *Neijing*, one cannot recognize diseases; without *Bencao*, one cannot recognize herbs; without *Maijing*, how can one diagnose via pulse? Only then should one consult the theories of various schools."

Yet another asked: "Zhang Zhongjing's *Treatise on Cold Damage* presents symptoms and corresponding formulas, serving as the ancestor of medicine. Should it also be read first?" The answer was: "What enters the mind first often becomes dominant. The *Neijing* exhausts the wonders of yin and yang, with infinite variations; all other books derive from it. For instance, Bian Que's *Eighty-One Difficulties* captures only a fraction of the *Neijing*. Zhang Zhongjing selected the aspect of cold damage; Liu Wansu (Hejian) altered Zhang's methods focusing on heat; Li Dongyuan established his theory based on dietary irregularities and overwork. If one prioritizes Zhang Zhongjing's book, focusing on cold damage, one might mistake internal injury for external contraction. If one prioritizes Li Dongyuan's book, focusing on stomach qi, one might mistake external contraction for internal injury. If one prioritizes Liu Wensu's book, focusing on heat, one might mistake cold for heat. It is better to prioritize the *Neijing*, so that one's understanding naturally becomes flexible and dynamic."

Another asked: "Current physicians merely look at the *Pulse Jue* (*Pulse Aphorisms*) for diagnosis, ignoring other formularies, believing this is simple and effective. Your teaching emphasizes reading the *Neijing*. Although it helps recognize disease, it lacks specific formulas, and the *Maijing* has thousands of threads, making it hard to search." The reply was: "Precisely so. Human life is extremely precious. Without accumulating years of effort, how can one lightly treat others' illnesses? Predecessors' theories and formulas either align with the *Neijing*, are forced interpretations, have biased intentions, or are formulated based on the patient's deficiency/excess, form, spirit, suffering/joy, pulse, and symptoms. Disease changes infinitely; people's constitutions and emotional states vary; suitable treatments differ by region. Even with similar symptoms, treatments differ. Without reading the *Neijing*, relying solely on existing formulas leads to errors; if mistakes occur, death is irreversible. Others may not know, but can one rest easy in conscience? Pulse theory is subtle, connecting to the principles of yin-yang creation. Sages discussed its beginnings and kept its depths secret. A skilled pulse-taker deduces from these clues. Can Gao Yangsheng's few lines in the *Pulse Jue* cover infinite diseases?"

Mr. Zhu said: "The learning of Liu Wansu and Zhang Congzheng discusses six aspects of zang-fu qi transformation, particularly emphasizing pathogenic factors of dampness-heat and ministerial fire. They treat these by pushing out the old and bringing in the new, and purging fire. This certainly surpasses previous generations. However, in cases of yin deficiency with fire hyperactivity, or dual deficiency of yin and yang, or self-generated dampness-heat, treatment must be carefully considered. Li Dongyuan stated that dietary irregularities and fatigue injure primordial qi, preventing the yang of the epigastrium from ascending, causing qi of the heart and lungs to sink into the middle jiao. He treated this with herbs like Buzhong Yiqi Tang. This was also unprecedented. However, heaven is deficient in the northwest, earth is incomplete in the southeast. Heaven is yang, earth is yin. People in the northwest have qi that descends easily; people in the southeast have yin qi that ascends easily. Ignoring this and merely copying methods means that while descending qi disorders may respond, applying descending methods to ascending qi disorders will likely worsen the condition. One should synthesize the three schools, discarding flaws and adopting strengths." He added: "Considering yin deficiency and yang excess, people suffer more from ascending qi and less from descending qi. Supplementing yin to balance yang allows water and fire to ascend and descend naturally, known as the positioning of Qian and Kun, and the interaction of Kan and Li."

Generally, when treating diseases and prescribing herbs, one should not act rashly regarding predecessors' unverified formulas. One must deeply ponder and analyze, seeking the source of qi amidst countless complexities. This is the work of investigating things to extend knowledge; over time, one will enter the wonder of infinite changes.

Commentary: "The Five Movements and Six Qi are thoroughly discussed in the *Neijing* but neglected in other texts. Their principles are profound and difficult to grasp. Please elucidate them." The reply was: "At the beginning of studying medicine, one must understand pathogenesis and changes, assess the person's constitution before treating. If one focuses too early on qi movements, one risks falling into the trap of Ma Zongsu, claiming 'a person born on such-and-such day suffers from such-and-such meridian disease and should be treated with such-and-such herb.' Human organs correspond externally to heaven and earth, governing qi and movements, responding to the eight winds. Is this not appropriate? Without knowing this, a physician has not grasped the principle and cannot regulate. Yang Taishou often said: 'Five Movements and Six Qi must be observed daily, recording wind, rain, and darkness. Some diseases arise on schedule, some lie dormant and appear later, some are triggered by chronic conditions.' With thorough experience, one eventually reaches the pinnacle."

Treating disease and prescribing herbs is like using a balance scale; not a hair's breadth of error is allowed. Using ancient formulas for modern diseases without adjustment guarantees some degree of error.

Mr. Zhu said: "When I treat diseases, I use herbs following Li Dongyuan's principles and prescribe formulas following Zhang Zhongjing's style. Fewer ingredients mean more concentrated medicinal power." Asked: "What if one does not understand parts of the *Suwen*?" The reply was: "It is an ancient text with many missing characters and errors. Understand what can be understood, leave doubts aside. Wang Bing's annotations sometimes force interpretations or miss the original meaning. One must strive to read and savor it repeatedly."

Asked: "Beyond the *Suwen* and *Nanjing*, which books are essential?" The reply was: "For external contractions, follow Zhang Zhongjing; for internal injuries, follow Li Dongyuan. Zhang's methods align closely with the *Neijing*. However, one should browse all books to broaden knowledge."

Asked: "You treat patients with identical symptoms differently, not due to regional differences or age/lifestyle variations. Why?" The reply was: "Yin-yang qi movements are uneven. Endowment varies in thickness; the five qi have excesses; zang-fu organs differ in hardness and softness. Medication suppresses strength and supports weakness to achieve balance. How can treatment be uniform?"

Asked: "Some formularies emphasize hot herbs, others cold herbs. Is this due to season or geography?" The reply was: "When analyzing formulas, one must know the intent, adopt strengths, and discard weaknesses. Human nature tends to be biased; those who are open-minded are rare. Since ancient times, how many have there been?"

Asked: "A patient lies bedridden for a long time. After the main prescription is set, why are there additions and subtractions later?" The reply was: "Internally, there are differences in national (internal environment) deficiency and excess; externally, there are changes in the eight winds, seasons, qi movements, and emotions. Thus, while the main medicinal herbs remain unchanged, the assistant and guide herbs must be adjusted."

Asked: "What is meant by 'open-minded'?" The reply was: "Having no preconceived notions, one can exhaust the subtleties of change, recognize timely measures, and combine the essence of two and five to create harmonious qi. Deficiency is tonified, excess is purged, cold is heated, heat is cooled, rising is suppressed, sinking is lifted. With no bias, heaven and earth find their place, and all things flourish."

Reflecting on Cheng Wuji's commentary on the *Treatise on Cold Damage*: "Cold damage disease is primarily about yang qi." In these words alone, one sees deep attainment of sage wisdom. Heavenly pathogenic qi damages human qi; diet,起居, and seven emotions damage human form. Deep down, qi disease manifests in form; form and qi disease follow each other. Treating disease requires seeking the root.

Mr. Zhu said: "Zhang Zhongjing treats cold damage focusing on 'cold,' using acrid-hot and sweet-hot herbs, addressing immediate illness. Liu Wansu treats heat disease focusing on 'heat,' using acrid-cool agents, addressing latent illness where cold toxin hides in skin and muscles, transforming into warm disease in spring and heat disease in summer."

Asked: "Regarding the substance and function of yin-yang, you previously used heaven and earth/sun/moon as metaphors for substance (yin deficiency, yang excess), and breathing/ascending-descending for function. I have heard this. Although the substance of yin-yang deficiency/excess differs, their function of ascending/descending shares mechanisms. Since there is no reduction, and yin substance is originally deficient, why use tonification?"

Mr. Zhu said: "Shao Yong said heaven and earth rely on each other; heaven relies on form, earth relies on qi. Form has boundaries; qi does not. Human form is bounded. After Tian Gui ceases, form declines. If one does not benefit yin to guard internally, yang cannot exert its vigorous movement. Heaven loses its foundation, becoming scattered like a stray dog. Yang scatters, earth loses attachment. Form and qi detaching leads to death. One must nourish the damaged and decaying constitution."

Mr. Zhu said: "Treating disease requires distinguishing blood and qi. If qi disease is treated by tonifying blood, it may not hit the target but causes no harm. If blood disease is treated by tonifying qi, blood becomes more deficient and scattered, leading to dual deficiency of qi and blood. This is punishing the innocent. Diseases lighter by day and heavier by night indicate blood disease; heavier by day and lighter by night indicate qi disease, because day is yang and night is yin."

Inscription on the Desk: "Learning distinguishes principle from desire and opens ignorance. Food and clothing prevent hunger and cold and spread kindness. Words and deeds should leave good examples for descendants. Intentions should not offend heaven and earth."

Inscription on the Health Preservation Medicine Room: "Prescriptions for treating disease must first protect primordial qi. When attacking pathogens, adjust dosage carefully. Mild pathogens require mild doses; severe pathogens require strong doses. If primordial qi is deficient, be cautious with strong doses. Seek the root, like a stream has a source. Focusing on branches and forgetting the root leads to untreatable white-haired elders. Blood disease treats blood; qi disease treats qi. Examine zang-fu and meridians point by point. Tonify deficiency, purge excess. Observe color and listen to voice without slight error. Cold treated with cold, heat with heat. Distinguish dampness, dryness, and fire carefully. Weak qi opposes, strong qi follows. Opposition is direct treatment; following is reverse treatment. Adjust based on circumstances. Start same, end different. First consider annual qi, do not harm heavenly harmony. Violating seasons and transformations brings disaster. Use cold, heat, warm, cool appropriately. Ascend, descend, float, sink according to season. Reversal and compliance involve subtle principles. Exceptions exist, do not be rigid. Exterior diseases treat exterior; interior diseases treat interior. Between sweating and purging, life and death turn in a moment. Upper regulation uses slow methods; lower regulation uses rapid methods. Confusing slow and rapid invites blame. Acute diseases remove vigorously; chronic diseases treat gently. Balance gentleness and vigor. Sincerity in seeking cure must be cherished. Do not settle casually or轻视 this supreme dao. Untreatable diseases must cease quickly. Do not show leniency to invite criticism. These points are teachings from sage masters. Keep them clear in mind, walk correctly without doubt."

Mr. Qiu Kerong of Guangling said: "Physicians specializing in Liu and Zhang mostly use sweating, vomiting, and purging methods, based on Zhang Hezi's ten forms and three therapies. Whether wind, cold, summer-heat, dampness, dryness, fire, internal/external injury, or accumulation, regardless of location in the body, they believe these three methods suffice. Is this truly Zhang Hezi's legacy? Why does it differ greatly from the *Neijing* and Zhang Zhongjing? The *Neijing* says: 'Exuberant pathogenic qi indicates excess; depleted vital essence indicates deficiency.' And: 'Tonify deficiency, purge excess.' If pathogenic excess requires purging, the three methods might work. But if essence depletion requires tonification, are there no other treatments? They cite: 'Wood stagnation reaches release, fire stagnation emits, earth stagnation夺 (purges), metal stagnation drains, water stagnation bends.' Are these just aliases for sweating, vomiting, and purging? If there were no obstruction, would one blindly apply them? Zhang Zhongjing treated external contractions by dividing six meridians and distinguishing fu-zang organs, also using sweating, vomiting, and purging. Yet Taiyang has muscle-relaxing methods, Shaoyang has three prohibitions, and combined diseases use acupuncture. Surely there is reason? Zhang Hezi also said: 'Without reading Bencao, how can one know herb properties?' And: 'Recognizing disease and finding method makes one the best among workers.' Relying on three therapies for ten forms, why need to know herb properties? Perhaps Zhang Hezi's true works were lost during the Jin dynasty's southward migration, and this is a later fabrication. Obsessed followers turned reckless statements into absolute truths, mistaking deficiency for excess and fake cold for warmth. They ignore 'acting according to circumstances' and 'letting qi rest.' Scholars of antiquity, do you feel no regret?"

"Since the *Neijing*,历代名医 writings stored in government archives reached 179 authors, 209 volumes, and 1,259 scrolls by the Yuan dynasty—a large number. Yet how many are truly essential? Among them, the following seven books are worthy of emulation: Song Dynasty Cheng Wuji's *Clarifying Theory on Cold Damage*, Jin Dynasty Liu Shouzhen's *Original Causes Formula*, Yuan Dynasty Li Mingzhi's *Differentiation of Internal and External Injury*, *Medical Invention*, *Essentials of Living Methods*, Wang Haogu's *This Matter is Hard to Know*, Luo Qianfu's *Health Precious Mirror*, Zhu Yanxiu's *Analysis of the Formulary*, and our dynasty's Hua Borren's *Elucidation of the Fourteen Meridians*, Xu Yongcheng's *Analysis of Materia Medica*. These unlock the profundity of the Seven Classics and serve as the fundamental principles of substance and function."