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In ancient times, life and death were judged by observing a person's five qi (physiological manifestations corresponding to wind, summer heat, dampness, dryness, and cold), five colors, and five sounds. This essentially embodies the principle that "sincerity within manifests outwardly," and it also allows one to perceive diseases. Even when pathogenic factors are latent and not yet manifesting, the zang-fu organs have already been injured first; therefore, abnormalities must appear in the form, voice, and movements. It is like a house with a fire hazard: initially unnoticed, but once smoke and flames fill the room, the fire erupts violently and becomes uncontrollable. However, doctors who adopt preventive measures akin to "bending the chimney and moving the firewood" (metaphor for eliminating hazards) are rare nowadays.

The *Shuo Bu* records that Emperor Shenzong of Song was proficient in medical principles. An eunuch suffered from swelling, and the imperial physicians declared it incurable. The Emperor examined him himself and said, "Although yin qi is deficient, yang qi has not exhausted; it can still be treated." He prescribed garlic boiled with soft-shell turtle, which resulted in recovery. In the early Xining era, Lu Zhen, the prefect of the capital, entered the court to present memorials, followed by Zhou Yue, a Langzhong (mid-level official). The Emperor asked, "Is Lu Zhen healthy?" Lu Zhen did not answer. After a while, the Emperor asked again, inquiring how Zhou Yue perceived Lu Zhen's condition. Zhou replied that he seemed normal. Upon leaving the court, Lu Zhen looked in the mirror and asked Zhou, "Is my complexion dark?" Zhou said, "My Lord, do not doubt yourself; your countenance is calm and peaceful." Shortly thereafter, Lu Zhen fell ill and eventually died. Alas! One like Emperor Shenzong could be described as possessing the ability to "know through observation."

Pulse diagnosis, syndrome differentiation, and prescription formulation are the three essentials for physicians, with pulse diagnosis being particularly important. Once the pulse is clearly felt, syndrome differentiation naturally follows, making medication administration straightforward. Modern physicians, finding pulse theory difficult to rely upon, often abandon it entirely. They merely learn to write medical case records for show, valuing flexibility in argumentation and prioritizing mild medications, considering themselves superior to those who are dogmatic, curious, or reckless. They fail to realize that using medicine is like using troops; speed and agility are crucial. Hesitation allows pathogens to spread, leading to situations where rescue is impossible until critical danger ensues. While dogmatism is indeed taboo, if a prescription is unconventional, patients may hesitate to trust it; however, with mild prescriptions, although efficacy might be doubted, patients accept them because they are harmless. Ignoring this, the two characters "procrastination" cause significant harm. For ordinary ailments, abstaining from medicine may lead to recovery; but at the juncture of life and death, how can one delay even for an instant?

When I first read classics such as the *Ling Shu* and *Su Wen*, I found their meanings profound and pulse theories complex, often feeling discouraged as if facing an ocean. Later, focusing my mind, I extensively studied annotations by former sages. When doubts arose, I sat in silence all day, thinking hard and searching for answers, gradually comprehending the principles of the Five Movements and Six Qi, and Yin-Yang correspondences. Whenever I regulated breath and measured pulses to judge life and death, there were occasional instances of accuracy. Recalling my time hiding from war in the countryside, a Mr. Wu in the opposite alley suddenly collapsed while sweeping in the morning, remaining unconscious for some time before waking. I was summoned to examine him; he could sit up and talk. His pulse was rapid and sharp, resembling a pulling rope, indicating kidney qi exhaustion. The crisis would likely not last past nightfall. I hurriedly left, though others disbelieved me. Indeed, before noon, he passed away.

Another case involved a cloth merchant, Mr. Zhou, who sought treatment for a minor ailment. I stated, "Your current condition will resolve without medicine, but your heart pulse is uniquely firm, indicating damp-phlegm obstructing qi mechanism. Excess qi generates fire; if fire stagnates, carbuncles may develop." At that time, Mr. Zhou had small sores on the back of his neck, clustered like beads. I warned, "Though you feel no pain now, if these erupt, the harm will be severe; please be cautious." He ignored me. By the following spring, he indeed died from a toxic eruption on the back of his neck. Thus, judging syndromes via pulse seems as responsive as an echo. Yet, pulse theory is subtle and elusive, containing aspects that cannot be subjectively deduced.

A relative visited my study, appearing exhausted. Learning he had suffered from coughing for a month with shortness of breath upon exertion, I examined his pulse. It was erratic and rapid, like burning firewood. I internally suspected his heart spirit and essence were depleted, predicting death akin to withered grass. Being a poor scholar, I did not state this explicitly but gave him two taels of silver, advising rest. It was mid-autumn with frost; visiting him later after leaves had fallen, I found him recovered. Reflecting on this, perhaps during our consultation, the sun had set, and his hurried walking exacerbated his cough, causing qi stagnation and chaotic pulse presentation, creating that ominous image. Only in this instance did he recover, so I dare not claim confidence in my skills. Pulse theory is profound and subtle, difficult to analyze meticulously. Yet, modern physicians and patients prioritize pulse diagnosis, unaware that it ranks last among the Four Diagnostic Methods (Inspection, Auscultation/Olfaction, Inquiry, Palpation). A superior physician seeks completeness; while abandoning pulse to discuss disease is difficult, relying solely on pulse without considering disease is also impossible. In clinical practice, one must first inquire about the location and cause of the disease, observe deficiency/excess and complexion, forming a preliminary conclusion before palpating the pulse to resolve doubts. If the pulse contradicts symptoms, one must investigate the underlying causes of both the disease and the pulse discrepancy. Prescriptions based on this may avoid errors. It is not solely dependent on the Three Positions and Nine Pulses. Moreover, incompetent practitioners, knowing little of pulse theory, pretend to understand, claiming disease origins are known by pulse alone. Patients believe in their deep expertise, assuming clear insight under the fingers. Little do they know that ancient masters did not possess such infallible abilities either! My words are not to belittle pulse diagnosis but to emphasize its profundity, forbidding false pretenses.

Pregnancy and childbirth are not inherently pathological. Ancient miscellaneous records mention five types of abnormal deliveries deemed incurable, which are absent in medical formularies. What are they? First, "Binding": the umbilical cord tightly binds without release. Second, "Rushing": during labor, upward rushing prevents descent. Third, "Protruding": the fetus lies transversely in the abdomen, limbs hidden. Fourth, "Holding the Heart": the fetus presses against the mother's heart, causing the heart to descend with the fetus. Fifth, "Coiling Intestines": intestines rupture before delivery. Surviving any of these five scenarios, preserving either mother or child, is fortunate. Gestation periods vary greatly; some last three to four years due to fetal qi characteristics. Waiting quietly causes no harm. However, mistaking prolonged abdominal distension for illness and treating it with purgatives inevitably leads to fetal loss and abortion, bringing regret. Others deliver in the fifth or seventh month. Historically, delivery at five months was called "Gai Tai" (Complete Fetus), attributed to robust parental qi where yang generates and yin grows rapidly, leading to premature birth. Like plants facing the sun, receiving qi early, they bloom in ten months without waiting for spring. Laypeople misunderstanding this slander such cases, causing mothers despair, which is truly lamentable.

Previously, a grave keeper named Zhao Delong married a neighbor's daughter and fathered a son in less than six months. Relatives mocked him, but Zhao knew his wife was virtuous and harbored no suspicion. The child grew up resembling Zhao in voice and mannerisms, dispelling doubts. Another case involves prolonged pregnancy without delivery. The *Yuan Ren Shuo Bu* records Gu Shouwu, a salt worker in Nan Yi, whose wife Wang Shi had five children after marriage. In the Xin Hai year of Zhida, she became pregnant again. At term, labor lasted seven days without delivery. She instructed her family to cremate her immediately upon death, checking the abdomen to identify the anomaly. In October of the Geng Yin year of Zhengtong, her abdomen moved violently, and she died in extreme pain. Two days later, per her wishes, she was cremated. Inside, the umbilical cord was tightly bound. Cutting open revealed a male fetus with ribs hard as iron, calculated to have been gestated for forty years. The woman was born in Jia Xu and died at seventy-seven. Such anomalies in common events remain inexplicable.

Ancient saying: "Reading without understanding meaning is better than not reading at all," warning against being confused by texts. This applies especially to medicine. Ancient formulas addressed single symptoms without accounting for disease progression, allowing intuitive understanding but forbidding rigid adherence. Consider consumptive disorders. Zhu Danxi argued yang is often excessive and yin often deficient, focusing treatment on the Heart and Kidney. Since the Heart governs blood and the Kidney governs essence, essence depletion and blood dryness lead to hyperactive fire and declining metal (lung), resulting in consumption. Treatment used Si Wu Tang (Four Substance Decoction) and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) to tonify true yin, suppressing fire and clearing lung metal. Li Dongyuan, conversely, emphasized the Spleen and Stomach as the root, stating thick earth strengthens metal and nourishes kidney water, advocating Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Later generations revered Li and dismissed Zhu, arguing that creative vitality relies on spring-warmth qi; using heavy, yin-cooling agents extinguishes generative energy. This reflects ignorance of the principle that upper damage follows yang and lower damage follows yin. According to the *Jin Gui Yao Lue*: "A large pulse indicates consumption; extreme emptiness also indicates consumption." A large pulse signifies damage to Heart and Spleen, with deficient nutritive blood and leaking qi, requiring Gui Pi Tang (Restore the Spleen Decoction) and Jian Zhong Tang (Establish the Middle Decoction) to tonify qi and nourish nutritive blood. Extreme emptiness indicates internal deprivation of essence and blood in Liver and Kidney, with yin unable to stand independently, requiring Si Wu Tang and Ba Wei Wan (Eight-Ingredient Pill) to strengthen water and transform sources. Thus, former sages had distinct insights; later practitioners, ignoring yin-yang and pulse theory, treat consumption blindly without locating the deficit. Alas! Medicine cures but also harms. As the saying goes, "Without a good doctor, better not to take medicine." Treating disease is easier; managing medicinal side effects is harder.

A friend living remotely complained of having no doctors or pharmacies nearby. I remarked this might be a blessing for the village. Treating disease requires assessing deficiency and excess; do not exacerbate excess or deplete deficiency. Unblock qi and blood, ensuring harmony. This is the therapeutic principle of the *Su Wen*. Modern physicians often prescribe warming tonics for the elderly. The word "tonic" is pleasing. However, elderly people have declining spleen qi; food intake fails to transform properly, steaming into phlegm, obstructing qi mechanism. Excess qi generates fire. Thus, treating the elderly resembles treating children: prioritize clearing and unblocking, aligning with the classic teaching that the fu organs transmit and transform without storing, functioning through unblocking. Xu Lingtai noted: "Millennium-old wood often burns itself due to yin exhaustion and fire flare-up, a natural law." Accumulated filth in ditches causes blockage. Understanding this, one sees that elderly diseases are not treated solely with warming tonics.

Wang Kentang of Jin Tan, over eighty, suffered from chronic spleen diarrhea. Warming tonics worsened his condition. Li Shicai of our county treated him with Ba Dou Shuang (Croton Seed Frost), purging several liters of phlegm-saliva, resulting in cure. This required Li's diagnostic skill and Wang's medical literacy to accept such treatment. Zhang Zihe stated: "Skilled practitioners treat excess first, then deficiency; mediocre ones treat either; erroneous ones make excess more excess and deficiency more deficient; only incompetent ones tonify deficiency and fear treating excess."

Once, someone contracted heart disease after a boat ride in the wind. The physician ground powder from hand-sweat accumulated on an old ship rudder and administered it, curing the patient. Using medicine by intuition seems playful but often hits the mark accurately, defying easy explanation. Lu Ling shared this with Su Dongpo, who laughed, "True. Burning a talented scholar's pen ash for a dull student to drink cures lethargy. Extending this, drinking water from Boyi's oath cures greed; eating Bi Gan's rice cures flattery; licking Fan Kuai's shield cures cowardice; smelling Xi Shi's earring cures severe disease?" Lu Ling laughed too. I argue this should not be taken too literally. Ancients often used herbs with similar forms or properties to reach the disease site, or relied purely on intuition, such as crossbow triggers accelerating birth, pestle chaff relieving dysphagia, rose monthly regulating menstruation, fans stopping sweat, snake venom guiding drugs upward, cicada slough removing corneal opacities. "Medicine is intention" fits this category. It shouldn't be judged by common sense, nor guaranteed to work. Those who are rigid invite ridicule from scholars like Dongpo.

Modern physicians seeing fever and rapid pulse often prescribe Chai Hu (Bupleuri Radix) and Ge Gen (Puerariae Lobatae Radix), believing dispersing pathogens ensures safety. They ignore that six exogenous pathogens manifest diversely; similar symptoms require different treatments. Warm pathogens contraindicate sweating; dampness contraindicates diaphoresis, as taught by ancients. Wang Jin San's *Gu Fang Xuan Zhu* compiles 113 Shang Han formulas, covering attacking, tonifying, warming, and cooling, not just releasing the exterior. Even for foot meridians, exterior-releasing methods should not be excessive. Profuse sweating during illness consumes primordial yang, leading to post-illness weakness. The *Shuo Bu* recounts Fan Yun serving Liang Dynasty Emperor Wu, awaiting investiture with Nine Bestowals. Falling ill with epidemic fever, he summoned Xu Wenbo for quick recovery. Wenbo warned recovery might prevent future treatment. Yun accepted, citing philosophical detachment. Wenbo heated the floor, laid peach and cypress leaves, and had Yun lie on them. Profuse sweating ensued, and Yun recovered next day. Two years later, Yun died suddenly. This illustrates the danger of excessive dispersion. Treating disease relies on medication, but differentiation is key. Clear differentiation brings confidence in prescribing.

During Yongle reign, Consort Zhang of the Eastern Palace missed her period for ten months, suspected pregnancy. Imperial Physician Sheng Qidong diagnosed non-pregnancy and prescribed blood-breaking herbs. The Crown Prince was angry, dismissing Sheng. A month later, illness worsened. Sheng was recalled, prescribed the same formula, but confined separately while the consort took it. Sheng's family feared execution, but Sheng remained calm. Three days later, loud cheers outside indicated Sheng received rich rewards. The consort expelled several dou of blood, and the illness resolved. True diagnostic insight removes hesitation in prescribing. Sheng Qidong was indeed a skilled physician.

The pulse theory in *Tai Su* analyzes the subtleties of Five Movements and the principles of creation, determining wealth, status, poverty, longevity, and mortality. This stems from understanding principles. Humans receive heaven-earth qi to live; five element qi hides in zang organs, connects to fu organs. In breathing, yin-yang opening/closing reveals creation's mysteries. Examining *Tai Su*, heart pulse is primary. The Heart is the master, governing bodily movement. Nobility/commonality depends on light/clear vs. heavy/turbid qi. Verses describe: "Clear, tight, elegant, surging heart pulse naturally leads to high office; smooth modulation without interruption brings lasting fortune and noble decrees." Clear pulse indicates clear spirit; turbid pulse indicates vulgar qi. Abundant prenatal qi yields vigorous spirit and full qi, resulting in clear, elegant, non-chaotic pulses indicative of nobility. Generally, men focus on Liver Wood (Xun position); women on Lung Metal (Dui position). Clear pulses are warm and moist like jade, distinct, neither sinking nor soggy, continuous. Turbid pulses are rough, spiritless, mixed rhythms, indistinct on pressure, like scattered dry sand, distinguishing status. Pulses divide into six positions with myriad variations, infinite yin-yang gathering/scattering and generation/restriction, profound as I Ching logic. Only those with innate wisdom can grasp their essentials.

Commoners rarely take medicine, so remedies show effect easily; elites take medicine preemptively, making treatment less effective when sick. Rich patients often see multiple doctors daily, competing for novelty, hoping for accidental success, leading to chaotic prescriptions and errors. A poem laments: "Deep halls hide unknown illnesses; noble bodies prompt doctors to try every prescription." Rich patients err from chaotic medicines; poor patients err from procrastination.