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The difficulty in understanding pulse diagnoses has been a problem since ancient times. Extreme deficiency may present with excess symptoms, and extreme excess may present with deficient signs; between these ambiguous presentations lie the differences of life and death. Scholars often conceal their ailments to verify the efficacy of physicians.

Can a physician locate the disease amidst obscurity and distinguish between deficiency/excess and cold/heat in ambiguous situations? If a physician unfortunately makes a mistake, they are ultimately unwilling to admit it, instead using clever excuses to cover up faults and preserve their reputation. Occasionally, there are cautious and honest practitioners who, while complying with the patient's words, also incorporate their own observations, treating with a mixture of both approaches. In my lifelong experience of seeking medical care, I usually silently observe their competence beforehand. When ill and seeking treatment, I must inform the physician completely of my symptoms so that they clearly understand the location of the disease before taking the pulse. Thus, the patterns of deficiency/excess and cold/heat are determined in my mind beforehand, and the ambiguities of the pulse cannot confuse them. Therefore, even an ordinary *Zhongyi* (Traditional Chinese Medicine practitioner) can often cure my illness. I only seek the cure of my illness; why would I make things difficult for the physician? (Su Shi)

Zhen Quan, due to his mother's illness, studied and practiced medical formulas with his brother Zhen Lizhan, becoming a highly skilled physician. He compiled diagrams such as *Mai Jing* (Pulse Classic) and *Zhen Fang Ming Tang* (Needle Methods and Acupoint Diagrams), which were circulated at the time, and later gained prominence through his medical practice. Xu Yinzong of Yixing was advised by some to write books for posterity. He replied: "Medicine is merely a matter of intuitive understanding; precise contemplation leads to mastery. The manifestations of the pulse are profound and difficult to clarify; what I understand intuitively, I cannot fully express in words." Ancient superior physicians relied primarily on observation and pulse diagnosis to recognize diseases, and only then could they identify the condition. When the medication matches the disease, using a single herb to attack the pathogen ensures pure medicinal qi and faster recovery. People today are not good at pulse diagnosis; they guess the disease based on subjective feelings and use multiple substances to hope for success. This is like hunting without knowing where the rabbit is, covering vast fields in the hope that someone might catch one—a very inefficient method. If one herb happens to work but other flavors counteract it, preventing focused effort, this is evidence of difficulty in curing. The subtleties of pulse diagnosis cannot be transmitted; arbitrarily prescribing formulas ultimately benefits no one. This is why I do not write books. (According to *Old Book of Tang - Biography of Zhen Quan*)

I recently heard that you took *Huanglian* (Coptidis Rhizoma) for your eye disease, consuming over ten *liang*, yet still did not stop. I wonder if this is true? If it is as reported, it is likely inadvisable. In my younger years, when my blood and qi were not yet settled, I was quite fond of theories regarding prescriptions. After studying medical classics for several years, I once recalled a Buddhist text stating: "Long-term consumption of *Huanglian* (Coptidis Rhizoma) and *Kushen* (Sophorae Flavescentis Radix) may eventually lead to heat sensations." At first, I did not believe it, but later I came to accept it. Generally, the five flavors enter the stomach and return to their preferred organs: sourness first returns to the Heart, sweetness to the Spleen, pungency to the Lung, saltiness to the Kidney. Entering the Liver, it becomes warm; entering the Heart, it becomes hot; entering the Lung, it becomes clear; entering the Kidney, it becomes cold. Entering the Liver belongs to extreme Yin, combined with blood and qi, all increasing its qi. If unceasing, the organ qi will become excessive, leading to imbalance. Although *Huanglian* and *Kushen* have a great cold nature, their taste is extremely bitter. Upon entering the stomach, they first return to the Heart. If taken for a long time without stopping, it causes excessive Heart Fire. Fire exceeding leads to heat; this is the principle. Eye diseases originate from Liver Heat. The Liver and Heart are in a mother-son relationship; the Heart is the son, the Liver is the mother. The Heart is Fire, and the Liver is also Fire. The Kidney is a solitary organ. Humans often suffer from "one water failing to overcome two fires." Now, the disease originates in the Liver, and long-term consumption of bitter medicines causes the Heart to become excessive. This is what is called "using fire to save fire," termed "increasing the excess," which is obviously inadvisable. Medicines are used to treat diseases; if used excessively, they themselves become the disease. I heard that when the illness first started, your health had already been damaged by seven or eight parts. You should properly restrict medication and carefully protect your diet, waiting for self-recovery, rather than expecting sudden removal like bursting a boil. I hereby submit these thoughts; please pay attention and listen, do not neglect them. (Qin Guan, "Letter to Qiao Xisheng on Huanglian")