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In the year Jia Chen, I was a guest in Li, living near the residence of Yuan Qixiang, a distinguished scholar (Zhengjun) from Xi'an. Mr. Yuan was already knowledgeable in medicine and fond of taking medicinal substances. When I first visited him, I saw medical texts and medicine bowls scattered messily on the tables and desks; it seemed he performed the compounding and processing of medicines himself. He once showed me a prescription and said, "This also comes from the hand of a famous person, but because the medicinal ingredients are mild and lack tonifying properties, I have temporarily set it aside." I said, "Do you understand the meaning of 'tonification' (Bu, 补)? Tonification is needed only when something is deficient. For example, if a hat or clothes are not damaged, trying to repair them to make them thicker and stronger would actually create flaws. Medicines can benefit people, but they can also harm them. If one can accurately observe Yin and Yang and distinguish the flavors and properties, occasionally selecting one or two herbs and using them appropriately can achieve miraculous effects. Is it necessary to rely on unusual prescriptions or rare ingredients? During the long days with much leisure, I will briefly narrate one or two cases treated by my experience to awaken those trapped in sleep/delusion. Previously, I treated the wife of Sima Miao Litang. She had amenorrhea for over a year, her abdomen gradually enlarged, she vomited and could not retain food, drinking only one or two cups of lotus root juice daily, and was waiting for death. I was invited to diagnose her. She was so weak that she could barely support her own weight, panting so severely she could hardly speak. Palpation revealed the three positions on the left wrist were fine like a wandering silk thread, while the Guan position on the right was uniquely large. I knew the disease was in the Jueyin channel and had damaged the Taiyin organ. Reviewing the previous doctors' records, some attributed it to Qi accumulation, others to mass formations (Jia, 瘕). They indiscriminately administered acrid, aromatic, dry, and dispersing agents, leading to a critical condition. Therefore, I used a sweet and緩 (Gan Huan, 甘缓 - sweet and relaxing) formula. After one dose, the rebellious Qi stopped; after two doses, appetite increased. Subsequently, using methods to nourish Yin and boost Qi, within a month the distension and fullness were completely eliminated. This case initially involved only fluid depletion and Qi stagnation, with Wood (Liver) overacting on Earth (Spleen/Stomach). However, due to excessive attacking and purging, Yin fluids dried up day by day, leading to uncontrolled Liver Yang and distress of the Yang Earth (Stomach). Yang Earth prefers softness; sweetness can relieve urgency. Administering sweet and relaxing agents treats the Liver, which thereby saves the Stomach; this is a method achieving two goals with one move.

Again, in the year Gui Chou, while staying in the countryside, there was a boatman's son who suffered from sores and ulcers in summer. The doctor prescribed bitter-cold substances. By autumn, edema gradually developed. Later, a pediatrician was consulted, who further administered diuretic and draining treatments, causing the swelling to worsen daily. The illness lasted half a year; he was left with only a breath of life and had been without food for two days. His father went to town to buy a coffin, preparing to await death. Someone suggested I knew medicine, so they came to my door seeking treatment. Seeing his sincerity, I went to examine him. The swelling was severe, making his face and features almost unrecognizable, and the pulse was too weak to palpate reliably. I reasoned that chronic illness leads to deficiency, and since he had taken many cold-cooling drugs, his Spleen Earth had further declined and affected the Kidney. Kidney water overflowed, the Sanjiao (Triple Burner) stagnated, water seeped into the skin and muscles. With excess water, Qi became short and threatened to collapse. I planned to urgently administer Du Shen Tang (Single Ginseng Decoction) to assist Lung Qi, as the Lung governs the Qi transformation of the whole body and embodies the principle of Metal generating Water. At that time, the situation was turbulent, and ginseng could not be found in the countryside. Instead, I used one liang of Xianju Atractylodes macrocephala (Xianju Zhu, 仙居术), instructed to decoct it strongly and take it slowly. After finishing one vessel, the rattling phlegm sound in his throat gradually subsided. Thereafter, I repeatedly administered Liu Jun Zi Tang (Six Gentlemen Decoction), heavily utilizing Ginseng and Atractylodes. Within half a month, the swelling completely disappeared. These two cases achieved efficacy with plain formulas, showing that prescriptions need not be exotic, but must be used appropriately." Mr. Yuan said, "Your methods are excellent. Whose teaching did you receive, and which school does your method belong to?" I said, "In my youth, being sickly, I abandoned the Classics, Histories, Philosophers, and Collectanea. After eating and sleeping, I only used medical texts for entertainment, at which time I could roughly understand them. Later, while attending to my father's illness, I stayed indoors for several years. Thus, I collected various books and devoted myself to studying the Ling Shu (Spiritual Pivot) and Su Wen (Basic Questions). My understanding of pulse diagnosis and medication adjustment gradually became coherent; this is how my medical practice was formed. Since then, whenever I had occasional insights, I recorded them, accumulating twelve volumes named Shi Qin Yi De (One Insight from Attending to Parents). I shall seek your correction when free." The next day, Mr. Yuan passed by my study, and I gave him the book. He subsequently asked me many questions about medicine. I believe that although human diseases generally do not deviate from Cold, Heat, Deficiency, and Excess, there are variations such as Deficiency containing Excess, Excess containing Deficiency, Cold transforming into Heat, and Heat generating Cold. In clinical treatment, one must seek the function of mutual restraint and the meaning of mutual generation, allowing them to coexist without conflict; this is considered good. As for the method of adjusting medications, it merely relies on the bias of flavors and properties to achieve results. For instance, as stated in the Nei Jing: Salty overcomes Bitter, Bitter overcomes Acrid. Generally, the physician relies on intuition/intent (Yi, 意), and the prescription relies on method/law (Fa, 法). One must read ancient texts without being bound by them, collect prescriptions without being confined by them, apply divine intent within the method, and exhaustively investigate principles beyond intent. This subtlety of adaptation depends on the individual. Mr. Yuan highly praised this. In the following spring, Mr. Yuan traveled to Chu Nan, and we parted. Later, war cut off communication. Recently, I received a letter stating that he intended to publish these superficial observations, laughing at himself for failing to comprehensively organize the works of former sages and boasting of his single insight, which might only invite ridicule from experts. However, for Mr. Yuan to appreciate goodness until old age, and for my clumsy manuscript to be preserved amidst chaos without being lost, how grateful I am! I specifically write down what we discussed to record the origin of our friendship.

Liangcang Shi says: I do not know medicine, but I have heard that medicine connects with the Yi Jing (Book of Changes). The meaning of Yi includes Bu Yi (Unchanging), Jiao Yi (Interchangeable), and Bian Yi (Changing); it moves without remaining static. This shows that medicine has no rigid attachments. It is appropriate to refer extensively to past words, but even more valuable is not being constrained by established methods. One should fill the belly (substance) and empty the heart (mind), respond naturally rather than necessarily. If medicine is like this, it would be sufficient. The discussions in this chapter exactly match what I wished to express; perhaps there is a sense of smiling at each other and understanding in the heart.