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The old gentleman's physique is lean and slender. He maintains his spirit through a life of indifference to fame and tranquility, making it impossible for pathogenic factors to intrude. Although his diet has always been moderate, he only defecates once every three days, and the volume expelled is even less than what is ingested.

Thus, his spirit is abundant, allowing him to think comprehensively about worldly affairs, and both inside and outside the court rely on his great strategic talents. Occasionally, after defecation, he experiences chills and fever that occur at regular intervals, resembling an exterior contraction. In reality, this is an interior injury, not an exterior contraction.

This is because he has long suffered from difficult defecation; straining injures the Qi. Therefore, when stool is expelled, Yin takes advantage of Yang, causing chills; after a moment, when things settle slightly, Yang reasserts dominance over Yin, causing fever. If it were truly chills and fever caused by an exterior contraction, why would they necessarily occur only after defecation? At this time, one should only use mild agents to treat the interior injury, with supporting and nourishing the Yuan Qi (Primal Qi) as the highest priority. Adding medicines for exterior contraction, which drive out pathogens and guide stagnation simultaneously, will inevitably worsen the interior injury. Why does the gentleman wish to treat the dryness in the intestines, while the physician wishes to eliminate the dampness retained within? They fail to consider that intestinal dryness is a constant state of peace and can be left untreated; even if treated, moistening the intestines and generating blood is acceptable. However, regarding it as Damp-Heat and using slippery, purgative drugs to drain it is a grave error. Generally, in lean individuals, the presence of Dampness constitutes "fullness" (substantial pathological state); with Dampness, there is moisture; without Dampness, there is dryness. To identify dryness as Dampness now is like identifying Fire as Water. Furthermore, the Bladder is the pathway for water fluids, and the Large Intestine is the pathway for grain residues. For an intestine that defecates only once every three days, mistakenly using slippery drugs leads to uncontrolled discharge. Yet, still refusing to realize the mistake, each time there is fecal incontinence, he boasts of the power of removing Dampness. Is there any logic in the world where Dampness exits through the Grain Pathway (anus)? It is merely that because the master temporarily feels relief from intestinal lubrication, the words are absurdly embellished. How could the waters of the vast ocean fill a leaking cup, instead causing the Yuan Qi to be depleted day by day? Initially, the alternating victory of Yin and Yang gradually develops into their separation; Yin is injured by diarrhea, and Yang is injured by sweating. The pulses at both Cun (inch) positions are floating and empty, indicating Yang Qi floating upward; the pulses at Guan (bar) and Chi (cubit) positions are minute and fine, indicating Yin Qi floating downward. They no longer support each other, and the situation trends toward irreversibility.

Although sweating occurs at times, dysentery/diarrhea occurs without pause. Ultimately, both Yin and Yang Qi are exhausted below. Stool is expelled urgently like an arrow, and the anus feels hot as if branded. At this point, using Slippery Stone (Hua Shi), Akebia Caulis (Mu Tong), Polyporus (Zhu Ling), and Poria (Ze Xie) to separate and promote urination to stop diarrhea ignores the fact that Yin deficiency naturally leads to the exhaustion of spring-like fluids; from where can urine come? This merely empties decades of accumulated waste in the intestines, forcing reliance on the stomach and epigastrium for supply. Food enters and, without needing to stay, is already drawn down. Over time, the stomach cannot provide enough, so it secretly drives down its own inherent filth. The odor is extremely fishy, the color white like pus. Once the filth is gone, the Qi of the intestines also disappears. Only the precious Yuan Qi of the whole body is wasted in these empty organs. Even if Ginseng Radix et Rhizoma (Renshen) is taken for major tonification, when the medicinal power enters the stomach, the intestines are empty; when it enters the intestines, the stomach is empty; when stool is expelled, both stomach and intestines are empty. Consequently, lower emptiness leads to upper congestion, chest and diaphragm discomfort, stubborn phlegm obstructing the throat, dry mouth and throat, and sleeplessness all night. All food must be light in flavor and texture for the stomach to accept it. At this stage, planning to nourish blood, calm the mind, regulate the Spleen, and dispel phlegm through slow treatment is extremely untimely.

When the levee at Xuanfang was breached, emperors and ministers lightly discarded gold horses, jade, and chickens for sacrifice, strategizing collective efforts to assist in pacification. May we apply the method of extraordinary appointment by the court to medicine? A commoner unaware of taboos might perhaps achieve success this way.

Attached Medical Discussion: The prescription uses Ren Shen (Ginseng), Bai Zhu (Atractylodes Macrocephala), Gan Cao (Licorice), Shan Zhu Yu (Cornus), Wu Wei Zi (Schisandra), Xuan Mu Gua (Chaenomelis Fructus), Bai Shao Yao (White Peony Root), Sheng Ma (Cimicifugae Rhizoma), Chi Shi Zhi (Red Halloysite), and Yu Liang (Haematitum). Ren Shen, Bai Zhu, Fu Ling (Poria), and Gan Cao form Si Jun Zi Tang (Four Gentlemen Decoction), the correct medicine for regulating the Spleen and Stomach. However, Fu Ling is omitted because its bland and draining nature may injure Yin. Instead, Shan Zhu Yu is used to gather the scattering Liver Qi, Wu Wei Zi to gather the scattering Kidney Qi, Xuan Mu Gua to gather the scattering Stomach Qi, and Bai Shao Yao to gather the scattering Spleen Qi and Zang Qi. Combined with the tonifying effects of Ren Shen and Bai Zhu, the moderating effect of Gan Cao, and the ascending effect of Sheng Ma, Yin and Yang are harmonized, causing Yuan Qi that rises to descend and that which descends to rise, gathering in the center without scattering. Thus, the pulse will not be excessive above, the abdomen will not rumble, sweating will not be profuse, and the anus will not feel hot. Diet and drink will naturally increase, and diarrhea will stop. Gathering scattered Qi is the critical juncture, hence these four ingredients are repeated to leverage their specific strength. Regarding the use of astringents to secure collapse, various drugs differ. Here, Yu Liang and Chi Shi Zhi are used for their specific ability to secure lower Jiao collapse. Moreover, the emptiness of the intestines and stomach cannot be filled except by these two substances; the intestinal filth having gone cannot be restored except by them. Their adhesive nature aligns with the saying, "When diseases of the lower Jiao are difficult to resolve, Haematitum and Red Halloysite must be used," for this very reason. Furthermore, since the smooth nature of stone damaged the body, the astringent nature of stone must be used to rescue it, further adhering to the principle of "similar energies seeking each other." Therefore, large doses of medicinal materials must be decocted into a thick paste, mixed with these two substances and taken orally. It is feared that if the medicinal power is too thin, it will not linger; thus, the method of drinking soup is used to ensure prolonged retention, and the method of drinking strong wine is used to ensure slow absorption. It is not meant to force the patient to consume the entire dose at once. The gentleman did not understand this intention; seeing the heavy dosage, he considered it difficult to use. Physicians nearby also argued against the use of these two astringent substances, unaware that among the Ten Categories of Medicinals, astringents constitute one category, just as the Seven Luminaries traverse the sky—how can one be missing? Moreover, Chi Shi Zhi is merely the red part of Earth, and Yu Liang is the hard exterior and soft interior of Earth. If treating Spleen/Stomach (Central Earth) disease by drawing upon Earth is deemed unsuitable, then the roots of herbs are certainly not worth considering. From the East Sea to the West Sea, in the world and future generations, if enlightened ones emerge, the principles will naturally be the same, and the light will not be obscured. If one insists on practicing only what one knows, lowly practitioners will succeed, and the illness will become dangerous. What can be said?

Upon hearing my name, the gentleman invited me with extreme respect. But upon seeing my discussion of the disease and prescription, he harbored many doubts. I, though unworthy, sighed briefly at the end of the prescription and departed gracefully. The next day, the gentleman told relatives and friends, "Yesterday's debate was very clear, but I have never taken Chi Shi Zhi or Yu Liang in my life, nor have eminent physicians like Lou Zhongyi ever used them." He attached the meaning of "not daring to taste what I do not understand." Hua Tianyu Xiaolian recommended treating Chen Yanzhi's illness, which was several times heavier than the gentleman's condition. Using Chi Shi Zhi and Yu Liang achieved success; the case record exists and can be reviewed. Later, when doctors were invited to the prefecture, tonic formulas provided slight relief. However, improper tonification led to increased appetite at night, complete leakage of Spleen Qi, a burning anus, sinking of Yang Qi that failed to ascend over time, eventually resulting in a gluteal abscess, which was finally cured by surgical treatment. Alas, why did the gentleman not serve the country personally?

Mr. Hu Youchen stated: "Sima Pingcha has served both internally and externally, possessing integrity, uprightness, wisdom, and practical experience; he is the Fangshu (reliable minister) of our time. Returning from Jinmen, imperial orders were issued again, and his reliance was intense. Sima remained ill and ultimately passed away. Had he followed Jiayan's (Yu Chang's self-reference) advice, even dying on the battlefield would have been better than dying in bed at home."