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This volume consists of Mr. Mao Duishan's casual medical records and discussions, which offer many insights into medical principles. Therefore, it is appended to the end of the *Medical Conversations* for the study of colleagues.
Recorded by Cao Bingzhang of Yinxian.

Xu Bingnan from Suzhou and He Shuitian from Qingpu were both proficient in the arts of Huangdi (Yellow Emperor) and Qibo, renowned in their time. At that time, a wealthy Liu family in Jinchang, Suzhou, had only one son who contracted Shanghan (Cold Damage Disease) in spring. The condition was critical, and physicians were at a loss, so they engaged these two doctors with heavy gold rewards. Upon arrival, Dr. Xu examined the patient for a long time and said, "Shanghan is the leader of all diseases; life and death depend on within a few days. If the disease is not identified accurately and medication is inappropriate, variations will appear immediately. There is an ancient saying of 'not taking medicine for seven days,' which does not mean Shanghan cannot be treated with medicine, but rather that medicines should not be lightly tried. If observations are not prudent, it is better not to use medicine than to recklessly administer drugs to hasten demise. Therefore, a physician must first differentiate the manifestations of the Six Channels (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin), palpate the pulse, observe the condition, and investigate the location of the pathogen before treatment can proceed. For instance, Taiyang and Yangming patterns are exterior syndromes, suitable for diaphoresis (sweating method); Shaoyang is half-exterior and half-interior, suitable for harmonizing methods; when pathogens enter the interior in Taiyin, and even deeper in Shaoyin, purgation (downward-draining method) is appropriate. If there are cold extremities, spontaneous sweating, and collapse of Yang, warming methods are indicated. As for Jueyin disease, where cold pathogens are firmly bound, only strong hot agents can dispel them. Although such conditions are critical, if one prescribes according to the disease without error, recovery is not difficult. Now, examining your young master's symptoms, this is Lianggan Shanghan (Double-Striking Cold Damage). Lianggan means that when Taiyang is affected, Shaoyin is simultaneously diseased; because one Zang and one Fu organ are internally-externally related, they jointly receive the pathogen, causing exterior and interior syndromes to erupt together. The two pathogens press upon each other, affecting both Yin and Yang. Rescuing the exterior exacerbates the interior heat; rescuing the interior intensifies the exterior urgency. It is like external invaders being strong while internal rebellion occurs; no state survives this. Observing the manifestations, changes will occur within dawn or dusk. Even if Bian Que were reborn, what could he do?" Before he finished speaking, the gatekeeper reported that Mr. He had arrived, and Dr. Xu withdrew to an antechamber. Dr. He entered and examined the patient, saying, "Winter injury by cold leads to warm disease in spring. Generally, cold transforms into heat. However, the body is currently not hot, and the pulse is deep and hidden, indicating that heat pathogens have sunk deeply, and closure from within is imminent. While palpating just now, I searched within the deep and hidden pulse: the left Cun, Guan, and Chi positions showed a Wiry (Xian) pulse, while the right side was slightly moderate (Huan). Symptoms include deafness, hypochondriac pain, alternating chills and fever that seem present yet absent, accompanied by epigastric fullness, scrotal retraction, and occasional coldness of the body like ice. A wiry pulse with deafness and hypochondriac pain indicates pathology in the Shaoyang channel, as the meridian traverses the hypochondrium and connects to the ears; epigastric fullness and scrotal retraction with a slight-moderate right pulse indicate pathology in the Jueyin channel, as the meridian traverses the genitalia and connects to the Liver. Since pathogens have entered the Yin aspect deeply, the body feels cold as ice. Differentiating the manifestations, both Shaoyang and Jueyin channels are diseased. Ancient texts state that for Shaoyang syndrome, using Chengqi Decoction for purgation might trap Taiyang pathogens, while using Mahuang Decoction for diaphoresis would further aid interior heat. Thus, Da Chaihu Tang (Greater Bupleurum Decoction) was established to resolve the exterior and purge the interior, achieving both appropriately. Currently, the teeth are dry and the tongue is short, indicating exhaustion of Yin fluids. If strong exterior-resolving and purging agents like Chaihu and Chengqi are administered, they will further deplete Yin, hastening demise. If treated as Jueyin disease and warming agents like Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) are given, it is like adding firewood to a fire. If bitter-cold drugs like Shigao (Gypsum Fibrosum) and Huanglian (Coptidis Rhizoma) are used, they will not move the pathogens but instead assist the frozen state. However, physicians must seek life in despair. When palpating, although both hands' pulses were faint and nearly absent, a thread of the Yangming Stomach pulse remained. Remembering that a thread of pulse implies a thread of opportunity, after repeated study, only the method of 'lightness can remove excess' remains. With light and clear herbs, Lung Qi might be ventilated, hoping for fluid recovery and slight clarity of spirit, allowing for other strategies later. I tentatively prescribe a formula. If taken, and if slight sweating occurs between Yin and Mao hours (3:00–5:00 AM), there is hope for vitality; otherwise, it will be too late." Meanwhile, Dr. Xu sat alone in the room, sent his servant to inquire, and requested to see the prescription. He laughed loudly, saying, "Can this formula cure this disease? If it truly works, I will take down my signboard and never speak of medicine again." This was overheard by Dr. He's servant and reported to the host. Dr. He told Mr. Liu, "I heard Mr. Xu is also here, which is excellent. Though we cannot meet tonight, tomorrow's prescription must be discussed together. Please keep him for me." Dr. He's boat moored by the river, and he stayed overnight. Dr. Xu wished to leave, but Mr. Liu begged him to stay. After taking the medicine, at the fourth watch (midnight to 1 AM), sweat indeed appeared, and the complexion and form slightly stabilized. Before dawn, Dr. He returned for a follow-up visit, joy evident on his face, saying, "The Chi pulse has risen; survival is possible. But we must keep Mr. Xu. I will treat this young gentleman's illness; if Mr. Xu leaves, I will leave too." Mr. Liu agreed. Realizing the disease had turned for the better, Dr. Xu felt ashamed and urgently wanted to leave. Mr. Liu said, "How could I say such things? If you leave, I certainly won't keep you. My child's life hangs in your hands; please pity us. Even if it costs a thousand taels of gold daily, I will not grudge it." Hearing this, knowing his previous words were mistaken, Dr. Xu fell silent. Dr. He went ashore several times a day. Within a few days, the patient could sit up and eat porridge. Dr. He then told Mr. Liu, "The disease is now cured, and I will return by boat. Mr. Xu has been kept here for many days against his will and surely wishes to return. Regarding the earlier mention of the signboard, perhaps I will pick it up on my way, or he may bring it himself. Please inquire for me." Dr. Xu thus asked Mr. Liu to mediate. Mr. Liu hosted a banquet to persuade him, even kneeling, until the embarrassment was resolved. Upon returning home, Dr. He found his nephew suffering from severe Shanghan, causing panic in the family. Dr. He diagnosed the manifestations as similar to Mr. Liu's son and said, "Easy to treat." He advanced one dose using the previous method, which failed; after another dose, the patient died. Dr. He sighed, saying, "Today I realize that life and death are determined by destiny, not by the efficacy of medicine or the skill of the physician." He wrote to Dr. Xu, confessing the matter and asking for forgiveness. From then on, he closed his practice and did not discuss medicine for several years.
Liangcangshi commented: The distinction between high and low is subtle and leaves no trace. By recording both physicians' arguments in detail without deletion, seemingly carelessly, although Dr. He achieved results, the ending appears muddled, leaving the case undecided. Only upon careful reading of both discourses does one realize that under the detailed record lies an unspoken judgment. Dr. Xu's behavior was intentionally misleading, creating a deceptive array. Marvelous.