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Jingyi (Scriptural Principles)

"To diagnose by observation is called 'Shen' (Divine); to diagnose by listening and smelling is called 'Sheng' (Sage); to diagnose by inquiry is called 'Gong' (Skilled); to diagnose by palpation is called 'Qiao' (Dexterous)." (*Suwen*, *Yellow Emperor's Inner Canon*)

"If a physician has not practiced for three generations, do not take their medicine." (*Book of Rites*)

"After breaking one's arm three times, one knows how to be a good physician." (*Zuo Zhuan*)

"If a person lacks perseverance, they cannot serve as a shaman or physician." (*Analects*)

Zheyan (Philosophical Sayings)

"Breaking one's arm nine times leads to becoming a physician." (*Chu Ci*, *Songs of Chu*)

"If one cannot be an excellent chancellor, one should become an excellent physician." (Fan Zhongyan)

"What patients fear is the multitude of diseases; what physicians fear is the scarcity of medical principles." (Bian Que)

Ancient Physicians: The superior physician treats the state, the average physician treats the person, and the inferior physician treats the disease; the superior physician listens to sounds, the average physician observes complexions, and the inferior physician diagnoses pulses; the superior physician treats disease before it arises, the average physician treats disease before it manifests, and the inferior physician treats disease after it has occurred. ○ Modern physicians do not ponder the principles of the classics to expand their knowledge; each inherits family skills and follows old traditions. In examining illnesses and asking about ailments, they strive only for eloquence. Facing the patient briefly, they immediately prescribe decoctions. When palpating the pulse, they check the Cun position but neglect the Chi position; they grasp the hand but neglect the foot. They do not compare the Renying, Dicang, and Cun positions together. They count breaths for fewer than fifty cycles. They do not know the short-term prognosis, nor can they determine the condition through the Nine Pulse Positions, showing no understanding at all. They fail to observe the Mingtang, Que, and Ting areas of the face, which is like looking at the sky through a tube. To distinguish between death and life under such conditions is indeed difficult; these are deep warnings for physicians. (*Qianjin Fang*, *Essential Prescriptions Worth a Thousand Gold*)

A physician must be a man of benevolence and love; otherwise, lives cannot be entrusted to him. He must be intelligent and understand principles; otherwise, he cannot be employed. He must be honest and virtuous; otherwise, he cannot be trusted. Therefore, in ancient times, when selecting a physician, one would choose someone whose virtue included benevolence, forgiveness, and universal love, and whose intelligence allowed for clear communication and flexible understanding. Such a person could know the order of heavenly timing and the Six Qi movements, understand the numbers of life, death, fortune, and misfortune, distinguish between deficiency and excess, determine the rhythm of favorable and unfavorable conditions, assess the severity of diseases, measure the dosage of medicines, penetrate subtle mysteries, and not miss any details. Only such a person could be called a good physician. (*Chuxue Ji*, *Beginner's Records*)

The Way of Medicine requires precision to understand its principles and breadth to achieve simplicity. Therefore, predecessors established teaching methods requiring students to first read Confucian books, understand the principles of the *Yijing* (*Classic of Changes*), *Suwen* (*Basic Questions*), *Nanjing* (*Classic of Difficult Issues*), *Bencao* (*Materia Medica*), and *Maijing* (*Pulse Classic*), without omitting any. Why? Because without the Four Books, one cannot comprehend the subtleties of principles; without the *Yijing*, one cannot know the waxing and waning of Yin and Yang; without the *Suwen*, one cannot recognize diseases; without the *Bencao*, one cannot recognize herbs; and without the *Maijing*, one cannot diagnose and know the patterns of cold, heat, deficiency, and excess. (*Yixue Jicheng*, *Medical Integration*)

One who does not know the *Yijing* is unworthy of being called a Grand Physician. Only by mastering the essence of principles can one establish accurate theories that remain flawless for ten thousand generations. Those who know medicine but not the *Yijing* are confined to fixed formulas and hold partial views. Viewing medicine as a minor art and the *Yijing* as divination is like measuring the sea with a gourd or glimpsing a leopard through a tube; how can such people discuss this profound subject? (*Yizhi Xuyu*, *Remainders of Medical Intent*)

Confucianism has Yao and Shun; the medical field has Xuanyuan (Yellow Emperor) and Qibo. Confucianism has Confucius; the medical field has Zhang Zhongjing. The Way of Yao and Shun is not transmitted without Confucius; the Way of Xuanyuan and Qibo is not revealed without Zhang Zhongjing. There is no Confucian in the world who does not read Confucius's books, yet many claim to be physicians without reading Zhang Zhongjing's books. (Cheng Jiaoqian)

Cang Gong (Chunyu Yi), the divine physician, had five daughters but no sons. His teacher, Gongcheng Yangqing, was also over seventy years old and had no son. Thus, medicine is not a technique for producing heirs. (Li Lian, *History of Medicine*)

Physicians must carefully nurture their spirit, devote themselves to their profession, and avoid any external affairs. For a physician relies on "Yi" (mind/intuition). Examining pulses, differentiating syndromes, and prescribing medications all depend on this intuition. If the spirit is insufficient, one becomes impatient and careless, finding it difficult to apply deep thought. ○ Sun Simiao wished upon physicians: "Let your conduct be square, your wisdom round, your heart small, and your courage great." Alas! The divinity and excellence of medicine are contained herein. Having a pure and cautious heart, acting with calmness and harmony, avoiding jealousy, eliminating greed, not ignoring the poor and lowly, not fearing fatigue, consulting medical classics with precision, and feeling compassion for suffering—this is called "Square Conduct." Constitution varies in thickness, age in youth and old age, body in fat and thin, temperament in slow and quick, status in noble and base, local climate in gentle and strong, weather in cold and hot, day and night in heavy and light, illness in new and old, and Qi movement in excess and deficiency. Knowing the constant and the variable, being divine and enlightened—this is called "Round Wisdom." Observation, listening, inquiry, and palpation should be detailed; tonification, purgation, cold, and heat treatments must be distinguished. One must consider that human life is extremely important and karmic retribution is inescapable—this is called "Small Heart." Tonify when tonification is needed, purge when purgation is needed, treat heat with heat [sic: likely typo in source or specific context, usually heat with cold], treat cold with cold. Using Didang Tang or Chengqi Tang appropriately can bring back spring; using Ginger, Aconite, or Lizhong Wan frequently can revive the dying—this is called "Great Courage." These four seem separate but are actually united. (*Fengshi Jinnang*, *Feng's Brocade Pouch*)

Medicine is the foundation; those with bodies rely on it for survival. "Xiang" (Imagination/Thought) refers to imagining past situations within the mind and assigning various names and words. Therefore, for those needing survival, one must imagine the normal state of the human body and the abnormal state to provide treatment. It is also said: Medicine relies on "Yi" (Mind), and the transformation of "Yi" is "Xiang." Using imagination to normalize the abnormal means the normal state is what the physician should imagine; thus, it is called "Medical Imagination." (Lu Buyuan)

A tutor should not have a rigid air; a geomancer should not have a superficial air; a Zen master should not have a staff-and-fly-whisk air; an alchemist should not have a cinnabar-and-mercury air; a physician should not have a formula-and-technique air. Only then are they like a line-drawing artist, a true master. ○ Physicians encounter patients from rich (Gao Liang - fatty/sweet food) and poor (Li Huo - coarse grain) backgrounds. Their schools of thought differ, making it hard to compare them. Those skilled in treating the rich specialize in Fu Zi (Aconite) and Gui Zhi (Cinnamon Twig) to gain fame. Those attuned to the poor excel in Zhi Ke (Tangerine Peel) and Ju Hong (Pomelo Peel). However, treating the rich is often difficult because their constitutions are delicate due to luxurious living; phlegm and fluid accumulate above, and spirit declines below. Even with external pathogens, Ginseng is needed to support other herbs. Treating the poor is easier because their constitutions are tough; exterior pathogens can be freely released, and interior pathogens can be aggressively attacked. Even with劳伤 (labor injury), one method suffices for multiple tonifications. (Zhang Luyu)

A physician is valued not for curing diseases generally, but for curing difficult diseases. A patient is valued not for merely hiring a physician, but for hiring a true physician. Things that anyone can do are not difficult; diseases that anyone can cure are not difficult. Only when things are difficult are they beyond common knowledge; only when diseases are difficult are they beyond ordinary physicians. Thus, extraordinary people are needed for extraordinary deeds; extraordinary physicians are needed for extraordinary diseases. The difference between high and low physicians is vast. Like climbing higher, each level offers a new view unknown to those below; like traveling far, each step brings new insights unknown to those lagging behind. Therefore, for knotty problems, sharp tools are required. Who can sing along to the high song of *Yangchun Baixue*? ○ The key for patients lies in choosing a physician. Choosing is not hard; trusting is harder. Trusting is not hard; remaining unconfused in crisis, having firm leadership, and preventing confusion (mixing red and purple) is even harder. If one does not understand this and listens to floating rumors, gathering many physicians, one fails to find the Qiji (steed) and ends up with a herd of inferior horses from Jibei. Where are the heroes of the Pi Bridge in the strategic tent? In crises, how can one bear the errors of mediocre and reckless doctors? In times of doubt, how can one tolerate chaos? One wrong move costs a lifetime. Hence, too many opinions lead to failure; too many doctors lead to defeat. Why? Because gentlemen do not follow the crowd. Distinguishing the superfluous is hard; yet recognizing the true physician is hardest. Appointing a physician is like appointing a general; both concern safety and danger. Is there no method to examine them? If we judge benevolence by caution, the timid look similar; if we judge wisdom by acuity, the cunning look similar; if we judge courage by decisiveness, the rash look similar; if we judge erudition by depth, the argumentative look similar. Stubborn people seem to have definite views; exaggerators seem to have strange plans. Reading a few articles makes one speak endlessly; hearing a few words seems solid. Those who do not reflect arrive late at the cliff; those who are self-righteous are incompetent until old age. Those holding both extremes hope for natural merit; those abandoning the Four Diagnostics are like blind horses walking. Those gaining a reputation for stability cause delays; those ignorant of flexibility lack clarity. Claiming specialization is never truly comprehensive; not understanding reason and principle, how can one be sage-like? Judging others by oneself is a key way of interacting, but not in medicine. Assuming others' Qi and blood match one's own is flawed; relying on the majority opinion (two out of three) for decision-making is also flawed in medicine. Small, large, square, and round talents must be complete; Shen, Sheng, Gong, and Qiao functions must be utilized. One who gathers spirit in interaction and illuminates hidden truths in the mysterious depths is worthy of being called a true physician and can bear the responsibility of life and death. ○ "Mingzhe" (Wise and Clear-sighted) means seeing opportunities to protect oneself. If doctor and patient are not clear-minded, treating disease is easy. The problem lies in human relations! Human changes are indescribable. If I have unique insight, do they know it? If they knew, why would they need me? Often, when a disease is critical, people still offer shallow advice from the side, saying this herb is usable or not, criticizing doses as too heavy or too light. If displeased, they speak ill later. This is the first situation requiring discretion. Some use mixed medicines without focus, changing minds suddenly, abandoning effective treatment for others' suggestions. New doctors criticize previous ones to show off, and when failure occurs, blame others. This is the second situation. For terminal illnesses, pitying the patient's plea, one might try a breakthrough treatment. If it fails, it shocks people and invites criticism. This is the third situation. In places of dispute and interest, fearing involvement, one should retreat. This is the fourth situation. Some despise doctors and favor shamans, using doctors only nominally. Some villagers do not care about the illness but want to boost the doctor's reputation. This is laughable and the fifth situation. Complex discussions, relatives seeking credit, internal discord, and capriciousness are all taboo for doctors—the sixth situation. All six must be remembered, especially regarding officials, who might turn merit into crime. Although one says, "I did my best, I love life," circumstances may not allow it. One must see opportunities to advance or retreat and protect oneself wisely. (Zhang Jingyue)

One disease treated by physicians is "Ignorance and Incompetence." Medicine can save lives or take them. Only learning saves; ignorance kills. Without learning, one cannot broaden knowledge, clarify principles, attain precision, master flexibility, correct errors, or remove abuses. Acting rashly in such cases nearly guarantees killing the patient. Some say: Medicine is passed down from teachers or ancestors; this is learning. But relying solely on this is far from true learning. Relying on the ease of listening prevents mental research. Adhering to fixed rules obscures the principles of divine change. It implies past sages were less trustworthy than one's teacher or father. Good learners, regardless of lineage, seek the principles of ancient sages. From *Linghu* and *Suwen* to modern texts, they explore carefully, possessing high insight and clear logic. When encountering a disease, they identify it truly and firmly, not confused by false theories or deceived by illusions, achieving mastery and reviving the dying. This is true learning. True learning makes skills divine. Merely listening and following fixed rules is not learning. Relying on this leads to partiality, shallowness, superficiality, and vulgarity. In practice, treatment becomes ineffective (scratching an itch from outside a boot) or harmful (cutting skin/blood). It is like drawing a cake to satisfy hunger or drinking poison to quench thirst. This imprecision stems from insufficient learning. This disease of incompetence needs urgent cure. ○ Another disease is "Inability to Differentiate Pulses and Syndromes." Physicians must confirm the syndrome before prescribing, and confirm the syndrome by examining the pulse. Clear pulse diagnosis leads to true syndrome differentiation, which leads to appropriate medication. Every syndrome has cold, heat, deficiency, or excess. Without differentiation, one acts backwards. Severe cases may present with cold resembling heat, heat resembling cold, deficiency resembling excess, or excess resembling deficiency. Medicating based on resemblance kills instantly. How to differentiate? By the pulse. For example, in Cold Damage, a floating, tight, rapid pulse that is forceful indicates Yang pathogen in the exterior. A deep, rapid, forceful pulse indicates Yang pathogen entering the interior. A deep, slow, fine, soft pulse indicates pure Yin without Yang. A floating, large, thread-like pulse indicates extreme Yin resembling Yang. Careful differentiation prevents hesitation and conflicting treatments. However, modern physicians rarely discuss this, simply stating "Herb X treats Disease Y." When asked about cold/heat/deficiency/excess, they are茫然 (at a loss). Even if they differentiate, they often mistake deficiency for excess and cold for heat, worse than not differentiating at all. Their inability to differentiate syndromes stems from inability to differentiate pulses. Some physicians claim pulses are unreliable. What else is reliable? Historically, when syndromes are doubtful, pulses decide. Ancients spoke of "following pulse not syndrome" or "following syndrome not pulse." Understanding this, "not following" is actually deep "following." For instance, a deep, fine, slow, choppy pulse is Yin-Cold, but symptoms include irritability, thirst, red face, and fever. Treating as Heat and clearing would be fatal. One must tonify and warm, not following the fake Heat symptom but the real Cold syndrome. Similarly, mania and climbing walls indicate Fire-Heat, but a pulse buried deep suggests Yin. Treating as Yin-Cold and warming would be dangerous. One must clear and purge, not following the hidden Yin pulse but the pulse of extreme Heat hiding. In short, follow the truth, not the false appearance. Failing to discern this leads to chaos. One erroneous prescription costs a life. This inability to differentiate pulses and syndromes needs urgent cure. ○ Another disease is "Negligence of Human Life." Proverb says: Physicians have a heart willing to cut their own flesh. How can there be negligence? Observing today, this seems untrue. Perhaps ancient words don't fit today. Modern physicians lack not only the willingness to sacrifice but also the desire to help. Patients eagerly hire physicians hoping for healing, but physicians act indifferent, sticking to old habits, using slow-acting drugs, hoping for effect. As patients die slowly, physicians feel no guilt, remorse, or pity, being more cruel than butchers. The cause is erroneous transmission. Famous teachers teach: "Do not use strong herbs, do not use heavy doses, keep qi thin and dosage light, so apprentices can easily handle them." Following this, physicians believe taking risks for severe illness is bad, so they leave the original disease to the patient. Alas! Hiring a physician is to remove disease. Leaving the disease defeats the purpose. Leaving a mild disease worsens it; leaving a severe disease causes death. "Returning the patient" means letting them die calmly. Thus, adhering to light prescriptions and the habit of leaving disease harms patients. Ignoring urgency, using inappropriate drugs to save reputation and profit, disregarding life and death. This negligence needs urgent cure. ○ Another disease is "Adherence to Fashionable Templates." Templates are convenient but harmful. Medicine involving templates is most convenient and most harmful. Fashionable learning is easy: no mental labor, no research, no pulse checking, no reading, no deep study of herbs or diseases. Just learn a few clichés. Seeing a disease, call it Fire. If the patient feels deficient, say "Deficient but cannot tonify." Or "Only mild tonification, no excessive tonification." Or "Clear and tonify together, no warm tonification." These few words please patients and bystanders. For herbs, select thirty+ light, weak options. Treat all diseases—cold, heat, deficiency, excess, male, female, young, old, mild, or critical—with these. Like wearing a wide hat that doesn't fit everyone; like chewing meat at a butcher's shop without eating it. Ginseng, Dang Gui, Bai Zhu, etc., beneficial to Yuan Qi, are deleted for fear of strong flavors causing errors and criticism. Light, clear flavors show no merit but also no harm, yet hide great harm. They cannot attack pathogens or support declining Zheng Qi. Patients die, and physicians' skills become terminal. This adherence to templates needs urgent cure. ○ Another disease is "Medication That Seems Correct but Isn't." The character "Si" (Seem/Like) is dangerously harmful. Confucius said: "Hate what seems right but is not." Medicine's balance lies in medication; medication's妙用 (wonderful use) lies in matching the syndrome. Today's "matching" is non-matching because it only resembles. For example, fever...