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The four volumes of *Yijian Fang* (Simple and Effective Prescriptions) by the Chen family were circulated in Suzhou. The first item in its preface states: Recently, whether in internal or external medicine, when a doctor receives a patient, they primarily seek to prolong the duration of the illness, unwilling to allow the patient to recover quickly. For those with means, although they do not spare expenses, they are unaware that a prolonged illness leads to physical depletion; the harm stems precisely from this. As for the poor who are ill, since they cannot all be treated free of charge, it is essential that they recover early so they can regain their ability to work and support themselves. If treatment is also delayed, they will inevitably lack the strength for further care, lie dying, and wait for death. Worse still, they may lose their livelihood due to illness, plunging their entire families into hunger and cold. Can one bear this? I hope practitioners maintain a mind dedicated to benefiting others and saving lives, strive to reverse this entrenched habit, and will surely receive good rewards.

Mr. Lu Shen'an compiled my medical cases in the *Third Compilation*. On page six of Volume Two, after the case of Lady Tu, wife of Magistrate Tu Xiaosu, there is an appendix regarding the symptoms of Mr. Gu’s son. The scholar Wang Xiecheng from Wucheng commented: "The phrase 'cured as soon as the cup is overturned' (implying immediate cure upon drinking the medicine) should be deleted below, as the statement is exaggerated." If this is the case, then could warm and acrid herbs be used for warm diseases and summerheat diseases among the poor? This comment is very correct, and I deeply admire it. However, the diet and lifestyle in Hangzhou are the best under heaven, surpassing even Suzhou and Yangzhou. Yet, children in wealthy families are often excessively cherished; due to pampering, they suffer from ailments caused by overeating and warmth more severely than elsewhere. Only those who have experienced such environments firsthand can fully understand this. My remarks here are made with specific reasons in mind. Therefore, I specifically wrote the four characters "combing wind and bathing in rain" (describing exposure to harsh elements) in the following text. For those who endure wind and rain, even if they contract warm pathogens or summerheat, it seems that pure cooling herbs alone are not sufficient for treatment. One should slightly assist with acrid-dispersing herbs to align with the therapeutic principle. Finally, concluding with "tailor the garment to the cloth" (adapt treatment to the individual) and "do not stick rigidly to fixed rules," I was worried about being blinded by preconceived notions and thus dared not speak definitively. The Jiaotai Pill (Harmony Pill) used on page twenty-two consists of two herbs: Huanglian (Coptidis Rhizoma) and Guixin (Cinnamomi Cortex). Mr. Lu did not annotate it, but I mention it briefly.

In the past, Dong Lanchi, Salt Commissioner of Wujin; Gong Haimen, a Shengyuan (licentiate); and Mr. Xiang Xinqiao of Siming, all claimed that I was the reincarnation of Mr. Yuan Jianzhai (Yuan Mei). Hearing this, I felt ashamed and dared not accept it. How could I possibly compare to Mr. Yuan’s intelligence, filial piety, fraternal duty, political achievements, and literary works? Our temperaments were merely somewhat similar in their openness and unconventionality. Yang Suyuan, Prefect of Dingzhou, said: "Yuan was a renowned physician of the age." In your case treating Scholar Hu Jicha’s carbuncle on the back, the quotes you cited already encompassed the treatment methods for all internal and external diseases without omission, yet no one for millennia has understood this. Only your cases, regardless of using tonification or clearing, employ the subtle art of regulating the pivot and unblocking collaterals. The comments from Mr. Lanchi and others likely stem from this. I consider this merely a trivial insight from a fool, coincidentally aligning with Mr. Yuan’s views. Regarding the discussions in his collected works, they are nothing but profound talks entering the principles. I often gain insights through his perspectives, which is indeed true. Because Qi in the human body values smooth circulation, all diseases arise from stagnation and obstruction. If one does not understand this, even if the medicine matches the syndrome, it often fails to interact effectively, let alone cure the disease. Therefore, in recording my humble cases, I do not shy away from verbosity, earnestly advising people of this truth. If one understands this principle, then mild medicines and light prescriptions can often cure severe conditions; even fatal diseases might be temporarily alleviated. Yet, ignorant people claim my miraculous skills and benevolent reputation spread far and wide. When patients present with myriad complex conditions that many struggle to diagnose despite intense effort, I resolve them with plain, commonly used substances. Is this not just good fortune in my medical career? I simply smile and do not answer. However, in the quiet of the night, examining my conscience, I feel ashamed of lacking substantial learning, yet I have fortunately acquired a false reputation, concealing much deficiency. Thus, I reside in a remote village, hoping to minimize errors. Yet, my passion remains undimmed, and why refrain from speaking? Alas, surely someone with wisdom will understand my intent.

My relative-in-law, Cai Xuabin, a Shengyuan, whose father, Mr. Gan Zhai, was proficient in medicine and practiced for forty years, once said: Medicine, in its apparent aspect, is like a tangible game of chess, responding to changes without fixed patterns; many are capable, but few are masters. In its hidden aspect, it is like the intangible Dao, divine and unfathomable; easy to practice, but difficult to truly know. He truly exhausted the subtleties of this field. Thus, after turning sixty, he vowed never to treat patients clinically again, preferring to engage in charity and kindness. Even without savings, he remained tireless. He lived to seventy-nine before passing away.

Mr. Yu Zhonghua from Shanyin was a senior disciple of Chen Nianyi from Xiafang Bridge. He was extremely generous, possessing a chivalrous spirit, enjoying drinking and discussing military strategy, valuing friendship over wealth, and devoutly practicing Buddhism. He resided long-term in the provincial capital and shared the deepest friendship with me. However, our views on medicine clashed; whenever I discussed Zhang Jingyue, anger would show on his face. I attributed this to his excessive loyalty to his teacher and did not argue. Nevertheless, when encountering severe seasonal epidemic diseases, he always instructed the patient's family to invite me for primary treatment. His two sons, however, were misdiagnosed and mistreated with warm-tonifying methods. Despite my urgent pleas and the strong admonitions of the late Filial Son Zhang Yangzhi, the father and sons remained unmoved. Such was our harmony in friendship but divergence in opinion. Mr. Yu once wrote a book titled *Jie Shuihu Yanyi* (Conclusion of the Water Margin Romance), also known as *Dangkou Zhi* (Chronicles of Pacifying Bandits), advocating for the court to suppress bandits, with a righteous intention. Unfortunately, his literary skill fell far short of Shi Nai'an's. Moreover, he erroneously applied the principle of "supporting Yang and suppressing Yin" to medicine, revealing a bias and error. Magistrate Yang Suyuan wrote an essay criticizing him. Given Mr. Zhonghua's talent and learning, yet still falling into heresy when discussing medicine, how can medicine be spoken of lightly! I record this to warn future generations not to discuss medicine casually.

"Supporting Yang and suppressing Yin" in the Great *I Ching* (Book of Changes) metaphorically refers to the gentleman versus the petty person. Zhang Xugu stated that this applies only to governing the world, not to treating disease, which is correct. I believe it can apply to treating disease, provided that supporting Yang and suppressing Yin does not rely solely on hot herbs. Why? Human primordial Qi is akin to Yang, while exogenous pathogenic factors are akin to Yin. Thus, heat damages stomach fluids, which Zhang Zhongjing calls "absence of Yang." To support Yang, one must replenish fluids; to suppress Yin (pathogens), one must eliminate heat. Although "urgent purgation preserves Yin," urgent purgation eliminates pathogens; eliminating pathogens is suppressing Yin, and preserving Yin preserves Zheng (Righteous Qi); preserving Zheng is supporting Yang. Understanding this, one sees that the principles of the *I Ching* and medicine are consistent. Zhao Yangkui failed to grasp this, knowing only that warm-tonifying drugs support Yang, unaware that Yin and Yang here metaphorize Pathogen and Righteous Qi. Consequently, his methods could only treat diseases caused by cold pathogens or syndromes of Yin excess repelling Yang. By naming his book *Yi Guan* (Medical Continuation), he confused later generations, harming countless people, justifying Xuxiling's (Xu Lingtai's) strong condemnation.

Xu Zhousheng, a Department Head from Renhe, said: Wu Taiqing firmly believed in divination via spirit-writing, kept long fasts, worshipped, ignored his emaciation, accepted Daoist precepts, and spoke not for a hundred days. In midsummer, summerheat-fire stifled his lungs, leading to hemoptysis and death. He therefore claimed that spirit-writing began with a few enthusiasts, then attracted simple folk, and eventually the intelligent. Misfortune and fortune are divined by it, knowledge is taught by it, and illness is treated by it. Turning away from Yang into Yin, abandoning clarity for darkness, its gloomy and heavy nature dissipates one's mental clarity. I believe there are even those who suffer calamity because of it, which can be verified. Generally, those bewitched by it fail to distinguish righteousness from profit and harbor delusional hopes. Recently, spirit-writing temples have expanded, and techniques have become newer, with some practices too abominable to recount, which is especially lamentable.

*Lengzhai Zasuo* (Miscellaneous Sayings from the Gen Study): Restrain anger so fire does not rise; curb desires so water does not leak downward. When water and fire interact and balance, the alchemical vessel is complete. The gentleman reads the image of the *Sun* hexagram (Decrease) and learns health preservation.

Plagues injure people most severely, as described in *Tangwang*, during the 16th year of Chongzhen. There were names like "Geda Plague" and "Yangmao Plague"; calling out the disease name led to immediate death, leaving no time. In August and September, millions died of plague. In October, a Fujianese man understood the cause: observing a protruding vein behind the knee crease, purple indicated incurability, while red indicated survival if blood was pricked out quickly. As frost and snow gradually descended, the epidemic subsided. I believe this plague, though strange, killed quickly and in large numbers because summerheat-toxic qi penetrated deeply into the Ying (Nutritive) level. Hence, light cases survived with pricking, and the disease declined with frost and snow. Examining Wang Gong's *Zhenyin'an Suoyu* from Jiaxing and Chen Songtao's *Zaihuan Jishi* from Tongxiang, both state that the 14th year of Chongzhen saw severe drought, and the 15th and 16th years continued with extreme drought, causing national famine and rampant plague. Synthesizing these three books, it is clear that this was summer-dryness-heat-toxic qi. "Calling the name leads to death" indicates pathogenic qi directly entering the Zang organs. Had someone like Yu Shiyu existed then, perhaps one or two could have been saved.

Tong Lu said: Mr. Zhong Jinglong from Zhenhai was proficient in treating smallpox and chickenpox. Of those he treated, none missed by more than one in a hundred; his predictions of prognosis for adverse cases were never inaccurate. His initial treatments involved Dahuang (Rhei Radix et Rhizoma) in five out of ten cases, followed by tonics in seven out of ten. For attacking and dispersing, he used only Jiangcan (Bombyx Batryticatus); he never used Quanxie (Scorpio), Chuanshanjia (Manis Squama), or Sangchong (Nepa Cinerea). Only Dilong (Pheretima) was used extensively, sometimes over a hundred earthworms, when blood-heat toxicity was severe. He once said: Children's Qi and Blood are not fully developed, and their Zang-Fu are delicate. Smallpox failing to erupt is indeed due to Yuan (Primordial) deficiency preventing sufficient pus formation. If pus is insufficient, toxins cannot be expelled. Using poison to attack poison not only fails to expel toxins but harms Zheng Qi further. There is no case where deficiency allows toxin transformation. His words were concise and profound, truly maxims for saving the world. I believe there are also cases where extreme heat prevents pus formation because Zheng Qi is consumed by vigorous fire. Fire should be drained, and tonification/resistance avoided. Sores after smallpox often result from reckless use of toxic drugs or mistaken warm-tonification.

Magistrate Yang Suyuan said: I have seen Dr. Zhao Gongfu from Fuping prescribe very lightly. He once said: A child's abdomen is small; one must ensure their Stomach Qi is sufficient to transform the medicinal power before it can be effective. This is also a profound truth. I believe that although Mr. Zhao spoke of children, adult illnesses also require weighing the Stomach Qi before adjusting prescriptions. Frail and thin individuals can be viewed similarly to children. In recent times, only Wang Guangqi from Xiuning treats children exclusively with light prescriptions.

My fellow townsman, Mr. Guan Rongtang, was a merchant in his youth, naturally intelligent, aware of his weak constitution and fearing a short life, he devoted himself to Surgery (Yangke) for over ten years, mastering the art. He was generous, distributing medicine to save people, able to rescue critical cases. We were bosom friends. In the winter of Bingchen year, he suddenly died of hemoptysis at age forty-four, leaving a son only five years old. Townspeople mourned him. I composed a couplet: "For years keeping a cold heart, giving medicine and grain, we sigh at your hot intestines; Once letting go of the red dust, this person and this illness, pity the yellow mouth of the child." One month before his death, while I was resting at home, he brought wine and food to visit and showed me his unfinished manuscript. He said: The origin of carbuncles and sores was traditionally attributed to three causes, but except for breast cancer and scrofula, there is no so-called internal cause. All exogenous Six Evils first cause internal disease. For example, incomplete sweating in Cold Damage or unclear resolution in Warm Diseases leaves residual pathogens lingering, forming internal abscesses, nodules, flowing deposits, or deep bone suppurations. These are caused by latent internal heat congealed by external cold. Even carbuncles on the chest and back arise from damp-heat rising. As stated, when Ying Qi does not flow smoothly and reverses in the flesh, carbuncles and swellings occur. Claims that Yin deficiency and flaming fire cause carbuncles account for less than one in a thousand. In summary, surgical disorders are nothing but Qi and Blood stagnation. Even trauma-induced disease is due to blood coagulation and Qi stagnation; there is no place for tonification. The purpose of taking medicine is originally to provide comfort for the wealthy, to calm their minds. One must absolutely avoid generic conformity. For instance, applying Neishu Huanglian Tang (Internal Drainage Coptis Decoction) to swelling causes toxins to turn black and sink; applying Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) turns the tongue gray-black. The Spleen and Stomach are damaged, and complications arise like swarms. Yet, this principle is unknown to patients, and even elderly physicians often do not understand the root cause. As the condition worsens, they do not blame their inappropriate medication but claim the disease is severe and requires heavier doses. They die without realizing anything, which is tragic! Even published case records are plagiarized or contradictory, offering no model for emulation. For example, Xue Lizhai frequently used Renshen (Ginseng Radix) and Fuzi (Aconiti Lateralis Radix Praeparata); for poor patients, this bankrupted families and took lives immediately. Moreover, modern surgeons ignore proper methods, relying solely on copying prescriptions, and spread the lie that refusing medication guarantees lingering toxins. Their intent is clearly fame and profit, disregarding life and death. I jokingly modified two lines from *Zuiweng Ting Ji*: "The doctor's intent is not in the disease, but in gathering wealth." A laugh. I regret my lack of study; I am unfamiliar with formulas and herb properties. Yet, whenever I treat ruined cases, success rarely comes from medication. Reading this, I admire his deep understanding, and his words resonate with my heart. I wished to discuss doubts, but alas, he passed suddenly. Heaven's way is unpredictable. I urgently excerpted the above to preserve his legacy.

He also said: It is ridiculous that traditional surgical texts name shapes based on fish, insects, birds, and beasts. Examples include "Eel Head" and "Mole Cricket String" on the head; "Dragon Spring Carbuncle" and "Tiger Whisker Toxicity" on the lips; "Snake Head Ding" and "Dung Beetle Bore" on hands; "Upper Softshell Turtle" and "Loach Abscess" on legs. None have explanations. More absurdly, "Niu Cheng Jian" (Ox's Step) on the heel compares humans to animals, bordering on mockery. Physicians ignore the meaning of names, inventing titles to confuse patients, who mistakenly view this nomenclature as expertise. This custom became entrenched and unbreakable. The reason is likely the inability to name based on acupoints, resorting to midnight tales to shock listeners. "Niu Cheng Jian" should be changed to "Xingcheng Jian" (Journey Impediment), and others named by acupoint. Those not in specific locations should simply be called "Wuming Zhongdu" (Nameless Swelling and Toxicity). Regarding "Biandu" (venereal buboes), they do not all stem from sexual frustration. Ancient texts attribute them to unfulfilled desires, which is likely incorrect. Even Syphilis is not solely caused by sexual toxins; damp-heat must be latent internally, triggered by sexual misconduct. If one lacks internal damp-heat, even frequent promiscuity will not lead to infection. If damp-heat is severe internally, infection can occur even without direct contact, merely by inhaling the pathogen's aura. Traumatic wounds becoming infected follow the same logic; one must not adhere to a single explanation.

He also said: The Surgical Wax and Alum Pill (Lafan Wan) is recorded in Materia Medica, extolling its detoxifying and heart/membrane-protecting effects. However, beeswax is extremely hard to digest, and alum damages the heart and binds the intestines. Patients consuming rich foods already struggle with digestion; introducing hard, binding, indigestible substances will certainly cause gastric closure and anorexia, worsening the condition. Even if wax protects membranes, swallowed into the gut, it may not reach the membrane. Can one trust prescription books entirely?

He also said: Ancient texts contain inaccuracies. Rich flavors cause carbuncles; changes from rich food produce large Ding sores. This is the basis for "dietary restrictions." I consider this advice tailored for the wealthy, not applicable generally. *Qianjin Yaofang* and *Waitai Miyao* emphasize dietary caution. Li Dongyuan said: Eating meat with carbuncles is self-abandonment. Ultimately, the contemporaries of these authors were all wealthy. Mr. Wang claims his skills treat only the poor, but as a Prefect, he was distant from common suffering. His "poor" were not the destitute laborers. Laborers' ulcers are caused by Six Evils invading externally. Ignorant doctors, unable to adapt, forbid vegetables and fermented bean curd, imposing numerous taboos per meal, causing near-starvation. Patients cannot endure this, leading to gastric closure and non-healing. This stems from unclear principles and imprecise skills, using "dietary restrictions" as an excuse to cover up faults. Yet, when prescribing, they recklessly use toxic herbs like Wugong (Scolopendra), Sangchong, Jiapian (Carapax Trionycis), Fengfang (Honeycomb), Shetui (Ophichthus Skin), and Jiaoci (Antler Spine). Why are ordinary foods strictly forbidden while these poisons are used freely? Habitual blindness invites deep sighs. If one restricts tonics for the wealthy and uses them appropriately for the poor, balance might be achieved. Sufficient Stomach Qi ensures easier recovery and tissue regeneration. Without this knowledge, how can one diagnose and treat effectively?

He also said: Ancient medicine did not distinguish between internal and external treatments. Knife, needle, Bian stone, puncture, steaming, moxibustion, ironing, and washing were all used, not relying solely on decoctions. Now these methods are lost, and reliance is placed entirely on decoctions. Thus, pathogens hide in collaterals, manifesting as carbuncles. Using medicine is like using troops. A general ordered to suppress rebels, abandoning discipline and failing to break enemy lines, merely handling paperwork, waiting for enemies to perish naturally, nurturing treachery and neglecting threats until the state falls, loses the way of a general. Similarly, surgeons abandoning knives and needles for carbuncles, failing to urgently drain pus and necrotic tissue, relying only on decoctions, waiting for spontaneous rupture, indulging in procrastination, nurturing the carbuncle until death ensues, lose the way of a physician. Xuxiling said regarding surgery: Manual techniques must be transmitted. This is true, but insightful students learn intuitively; otherwise, transmission is useless. Needles and Bian stones have been unused for long. Doctors choose the easy over the difficult; patients fear pain and seek comfort. This reflects current trends valuing empty reputation over substance. Society declines due to times and circumstances. Qin Qian said: "When medicine fails and needles cannot reach." Zhang Zhongjing treated Cold Damage with Mahuang and Guizhi for sweating; if sweat was incomplete, he used needle-pricking bleeding to substitute for sweating. Today, people say Mahuang and Guizhi are unusable and replace them, banning needling and slandering it as "draining Qi." This leaves pathogens trapped, causing lingering toxins. Historical records show emperors and generals treated with knives and needles, too numerous to list. Ask today's doctors if they would dare speak of this. Thus, it is the times and circumstances. In the past, internal diseases required external therapy; now, surgeons treat external diseases solely with decoctions. Excusing delay with tonification, mild cases waste resources, severe cases rupture or kill without burial shrouds. Doctors claim caution but kill invisibly; patients prefer comfort and die unawares. This is like Zichan's saying: "Water is weak; people play in it and drown." Unbelievable that medicine is the same. Do doctors intend to kill? No, they simply cannot distinguish pus from blood. Some can distinguish but delay for profit. Some cannot use knives/needles, relying on a few decoctions, feigning care to fool patients, denigrating needling as dangerous to hide their incompetence, labeling pustule-maturation as internal disease, and severe cases as fatal. If the patient dies, it proves their judgment; if they live, they claim credit and fees. Who am I deceiving? Heaven! Ancients warned against needling, meaning "avoid early use before pus forms," not a total ban. So, is medication forbidden? No. Initially, "sweating cures sores" applies to unresolved exogenous pathogens. "Do not sweat carbuncle patients" refers to formed sores, not a total ban. Post-care involves regulating Spleen and Stomach. Beyond these methods, no other search is needed. I believe early external lesions often stem from internal damp-heat accumulation or phlegm-fluid retention causing Qi stagnation and Blood coagulation. Clearing and resolving should come first. "Sweating cures sores" specifically addresses unresolved exogenous pathogens.

He also said: The *Zhengzong* rule of puncturing after ten days should not be rigidly applied. One must judge based on whether pus has formed. Judging pus is difficult; pus may form in one or two days without skin color change, or persist for ten-plus days with purple-black skin. The word "judge" is easy to say but hard to do! Fear of using knives/needles stems from unclear diagnosis. Starting with caution and love...